Incomplete rotator cuff tears. A technique for diagnosis and treatment.

The size and location of intratendinous and joint side rotator cuff tears can be diagnosed by a technique known as positional arthrography. The site and extent of the tears diagnosed preoperatively by this technique correlated well with intraoperative findings in a study group of 200 patients who underwent a combined arthroscopic and open procedure to localize, identify, and repair incomplete rotator cuff tears.

Anterior dislocation of the shoulder and rotator cuff rupture.

Thirty-seven patients older than 40 years of age were seen after sustaining primary anterior dislocations of the shoulder. An associated rupture of the rotator cuff in each patient had been missed, often being mistaken for an axillary neuropathy. Eleven of these patients developed recurrent anterior instability that was due to rupture of the subscapularis and anterior capsule from the lesser tuberosity.

Concurrent rupture of the rotator cuff and anterior dislocation of the shoulder in the older patient.

Thirty-one patients who were unable to abduct the involved arm after reduction of a primary anterior dislocation of the glenohumeral joint were found to have a ruptured rotator cuff. All of the patients were more than thirty-five years old. Twenty-nine of them were initially presumed to have had an injury to the axillary nerve, although this injury was confirmed in only four of the twenty patients who had electrodiagnostic studies.

The four-in-one arthroplasty for the painful arc syndrome.

The painful arc syndrome of the shoulder is a manifestation of rotator cuff tendinitis associated with tenosynovitis of the long head of the biceps under and just distal to the transverse humeral ligament. Eighty-nine patients with clinical signs of the painful arc syndrome were proven to have an associated biceps tenosynovitis by arthrography and at surgical treatment. The four-in-one arthroplasty consists of: (1) excision of the coracoacromial ligament; (2) acromioclavicular arthroplasty; (3) excision of the anterior inferior area of the acromion process; and (4) transfer and tenodesis of the long head of the biceps.

Adhesive capsulitis and the stiff and painful shoulder.

The author has endeavored to differentiate between the stiff and painful shoulder and adhesive capsulitis. Although the symptoms and the clinical findings can be quite similar, the arthrographic diagnosis and treatment are much different. Treatment is based upon the degree of severity of restricted motions and upon the dye capacity of the shoulder joint at the time of arthrography.