| As one of the main causes of shoulder pain and dysfunction,supraspinatus tendon injury is one of the most common shoulder disorders.Supraspinatus tear would result into injury and degeneration of the articular cartilage,eventually lead to shoulder joint disorder,hereby seriously affect the quality of the patient,s life,and cause significant burden on the family and society.Along with the improvement of average life span,the incidence of supraspinatus tendon injury has also increased.It is a great practical significance to carry out the in-depth study on the diagnosis and treatment of the supraspinatus tendon injury.The key to the recovery of the shoulder joint function depends on the early diagnosis and standard treatment which can evidently prevent disease progression and reduce disability rate.Part 1 Evaluation of the specific signs of shoulder and indirect magnetic resonance arthrography in the diagnosis of supraspinatus tendon injury.Objective: To investigate and evaluate the clinical significance of specific signs during physical examination of shoulder joint and indirect magnetic resonance arthrography in the diagnosis of supraspinatus tendon injury.Methods: From December 2014 to December 2015,90 cases of patients hospitalized in the Department of Sports Medicine of Shanghai Sixth People’s Hospital were subjected to diagnostic physical examination for supraspinatus tear including the Abduction resistance test(at 0。 degrees abduction),Drop arm test,Jobe,s test,Neer sign and the Hawkins-Kennedy sign.Indirect magnetic resonance arthrography was performed on all the subjects.Eventually,arthroscopy was used as the golden standard for diagnosis and assessment analysis.Results: Of the 90 cases,64 were diagnosed with supraspinatus injury by the arthroscopy,whereby there were 34 cases with full-thickness tears and 30 cases with partial-thickness injury.In the full-thickness injury patients,the sensitivity and specificity of the abduction resistance test were 48.0% and 65.0%,respectively for the drop arm test,51.9% and 72.2%;for the Jobe’s test,45.8% and 66.7%;for Neer sign,54.2% and 61.9%;for the Hawkins–Kennedy sign,84% and 60%.while in the partial-thickness tear patients,the sensitivity and specificity of the abduction resistance test were 46.2% and 57.9% respectively;for the drop arm test,39.2% and 64.7%;for the Jobe’s test,40.7% and 66.6%;for Neer sign,50.0% and 52.6%;for the Hawkins-Kennedy sign 45.8% and 57.1%.The sensitivity and specificity of the indirect magnetic resonance arthrography in the diagnosis of full-thickness supraspinatus injury was 96.7% and 93.3%,respectively,while for the partial-thickness injury,the sensitivity was 90.6% and the specificity was 92.3%.Conclusion: 1.Of all the different specific physical examinations and signs,the sensitivity of the Drop arm test and the specificity of Hawkins-Kennedy sign was the highest in diagnosis of the full-thickness supraspinatus injury cases.while for the diagnosis of the partial-thickness supraspinatus injury patients,the Jobe’s test had the highest specificity and Neer sign had the highest sensitivity.2.There was no significant difference in the sensitivity of the indirect magnetic resonance arthrography and Hawkins-Kennedy sign in the diagnosis of full-thickness supraspinatus injury.The specificity of the indirect magnetic resonance arthrography was higher than the specific signs.3.The sensitivity and specificity of the indirect magnetic resonance arthrography in the diagnosis of partial-thickness supraspinatus injury were both higher than the specific signs.4.The specific physical examination of shoulder joint with the characteristic of simple,quick and helpful for the diagnosis of supraspinatus injury should be recommended as the basic method of diagnosis.Indirect magnetic resonance arthrography can offer multiplane imaging and as a non-invasive diagnostic method with relatively high sensitivity and specificity rates,it can be used as important auxiliary diagnosis method.Part 2 Comparative study on the treatment of the simple supraspinatus injury repair and the supraspinatus injury repair combined with long head of the biceps fixation.Objective: To compare and assess the effect of two different arthroscopic surgical technqiue: the simple supraspinatus injury repair and the supraspinatus injury repair combined with long head of the biceps fixation.Methods: From December 2014 to December 2015,64 patients received arthroscopic treatment for supraspinatus injury were randomly separated into 2 groups: the simple repair group and the simple repair combined with long head of biceps(LHB)fixation group.Both groups were followed up and the pre-operative and post-operative pain visual analogue scale(VAS)scores,University of California Los Angeles(UCLA)scores,Constant scores and American Shoulder and elbow surgeon(ASES)scores and the range of motion(ROM)of shoulder joint were recorded.SPSS statistical software version 19.0 was used to analyse the effect of the two surgical techniques.Results: There was no significant difference in the general characteristics between the two groups.The operation time of the former group was 43 to 68 minutes(average 55.6±12.8 mins)while the latter,s was 50 to 71 minutes(average 65.6±15.3 mins)and the difference was statistically significant(P<0.05)between the two groups.Patients from both groups were followed-up for more than a year and there was no incidence of intraand post-operative complications such as neurovascular injury or infection.The VAS,UCLA,Constant and ASES scores of the simple supraspinatus repair group in pre-operative were 6.1±2.2,10.6±4.3,40.3±10.5 and 28.8±18.5 respectively.while for the simple repair combined with LHB fixation group,the scores were 5.9±2.4,10.8±4.5,41.2±11.1 and 29.3±19.1 respectively;there was no significant difference between the two groups(P>0.05).The pre-operative ROM of the simple repair group for shoulder flexion,abduction,external and internal rotation were 76.5±23.5°,72.4±35.2°,26.6±22.2° and 20.2±6.2°,while the same ROMs from the simple repair combined with LHB fixation group was 77.4±23.1°,72.8±36.6°,27.2±23.6° and 21.3±6.6°respectively,and there was no statistically significant difference between the two groups(P>0.05).3 months after the operation,the VAS,UCLA,Constant and ASES scores of the patients from the simple repair group were 4.4±1.6,17.3±4.9,51.7±13.7 and 38.8±21.9 respectively,while for the simple repair combined with LHB fixation group,the scores were 3.6±1.2,21.4±5.5,59.6±13.6 and 47.1±20.3 respectively;the difference between the two groups was found to be statistically significant(P<0.05).Simultaneously,the average ROMs for flexion,abduction,external and internal rotation of the simple repair group were 86.4±20.3°,81.4±35.2°,29.6±21.4° and 22.2±5.9°,while for the simple repair combined with LHB fixation group,the average ROMs were 95.5±24.6°,90.3±36.1°,34.1±22.2°and 26.2±7.2° respectively;the difference between the two groups was found to be statistically significant(P<0.05).6 months after the operation,the VAS,UCLA,Constant and ASES scores of the patients from the simple repair group were 2.7±1.5,22.3±5.3,66.3±11.9 and 56.2±24.6 respectively,while for the simple repair combined with LHB fixation group,the scores were 1.9±1.4,27.4±5.5,72..6±11.8 and 65.8±23.4 respectively;the difference between the two groups was found to be statistically significant(P<0.05).Simultaneously,the average ROMs for flexion,abduction,external and internal rotation of the simple repair group were 118.5±22.5°,98.5±35.3°,34.9±23.4°,and 28.3±7.1°,while for the simple repair combined with LHB fixation group,the average ROMs were 129.5±21.6°,107.3±35.1°,39.1±24.1° and 33.3±6.9° respectively;the difference between the two groups was found to be statistically significant(P<0.05).12 months after the operation,the VAS,UCLA,Constant and ASES scores of the patients from the simple repair group were 1.4±1.2,26.1±4.3,78.5±11.7 and 71.6±21.8 respectively,while for the simple repair combined with LHB fixation group,the scores were 0.8±0.7,31.8±3.1,83.4±12.1 and 76.8±22.9,respectively;the difference between the two groups was found to be statistically significant(P<0.05).Simultaneously,the average ROMs for flexion,abduction,external and internal rotation of the simple repair group were 142.8±18.6°,120.6±32.8°,42.6±16.2°and 38.4±5.6°,while for the simple repair combined with LHB fixation group,the average ROMs were 152.9±26.3°,127.8±34.1°,49.1±16.9° and 44.7±6.2°respectively;the difference between the 2 groups was found to be statistically significant(P<0.05).Conclusion: 1.supraspinatus tear can be effectively treated by arthroscopic surgery: both surgical techniques could effectively and significantly relieve the pain and ameliorate shoulder function of the patients and have good clinical effection.2.The operation time of the simple repair combined with LHB fixation was longer than that of simple repair operation,but the postoperative shoulder pain and function scores were better than the later.3.The combination of LHB fixation with supraspinatus repair has more advantages in the pain relief and improvement of shoulder function. |
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