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Non-insertional tendinopathy of the subscapularis

PURPOSE: (1) Describe a previously unreported finding involving the intra-articular portion of the subscapularis, the Conrad lesion. (2) Describe a novel classification system for the spectrum of non-insertional tendinopathy of the subscapularis. (3) Report the outcomes of surgical treatment of this...

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Autores principales: Dierckman, Brian D., Shah, Nirav R., Larose, Connor R., Gerbrandt, Stacey, Getelman, Mark H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3807950/
https://www.ncbi.nlm.nih.gov/pubmed/24167399
http://dx.doi.org/10.4103/0973-6042.118876
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author Dierckman, Brian D.
Shah, Nirav R.
Larose, Connor R.
Gerbrandt, Stacey
Getelman, Mark H.
author_facet Dierckman, Brian D.
Shah, Nirav R.
Larose, Connor R.
Gerbrandt, Stacey
Getelman, Mark H.
author_sort Dierckman, Brian D.
collection PubMed
description PURPOSE: (1) Describe a previously unreported finding involving the intra-articular portion of the subscapularis, the Conrad lesion. (2) Describe a novel classification system for the spectrum of non-insertional tendinopathy of the subscapularis. (3) Report the outcomes of surgical treatment of this spectrum of pathology. MATERIALS AND METHODS: Outcomes of 34 patients (23 males and 11 females, mean age 60.5 ± 7.5) with non-insertional tendinopathy of the subscapularis treated arthroscopically were retrospectively reviewed. All patients had anterior shoulder pain with no weakness during belly-press testing and no subscapularis footprint involvement on magnetic resonance imaging. All patients were managed with subscapularis tendon debridement and side-to-side repair along with treatment of concomitant pathology. RESULTS: Seven patients had a Type I lesion (so-called Conrad lesion) – a nodule on the leading edge of the subscapularis. Eighteen patients had a Type II lesion – a visible split tear with degeneration in the upper ½ of the intra-articular tendon. Nine patients had a Type III lesion – more extensive splitting in the tendon with advanced tendon degeneration. At a mean follow-up of 24 months, 97% of patients were completely satisfied. Significant improvements were seen in forward elevation (152 ± 12° to 172 ± 5°, P < 0.001) and visual analog scale pain scores (5.9 ± 1.7-0.6 ± 1.0, P < 0.001). Internal rotation strength and external rotation motion at the side were maintained. ASES scores averaged 95.4 ± 7.4, disabilities of arm, shoulder and hand scores averaged 6.19 ± 9.8, Western Ontario Rotator Cuff scores averaged 91.7 ± 9.3 and the average University of California at Los Angeles score was 33.1 ± 2.4. CONCLUSIONS: We present a previously unreported finding of the subscapularis, the Conrad lesion, along with a novel classification system for non-insertional tendinopathy of the subscapularis. Arthroscopic treatment of this spectrum of tendinopathy along with concomitant shoulder pathology eliminated pain and improved patient outcomes without detrimental effects. LEVEL OF EVIDENCE: IV, Retrospective Case Series.
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spelling pubmed-38079502013-10-28 Non-insertional tendinopathy of the subscapularis Dierckman, Brian D. Shah, Nirav R. Larose, Connor R. Gerbrandt, Stacey Getelman, Mark H. Int J Shoulder Surg Original Article PURPOSE: (1) Describe a previously unreported finding involving the intra-articular portion of the subscapularis, the Conrad lesion. (2) Describe a novel classification system for the spectrum of non-insertional tendinopathy of the subscapularis. (3) Report the outcomes of surgical treatment of this spectrum of pathology. MATERIALS AND METHODS: Outcomes of 34 patients (23 males and 11 females, mean age 60.5 ± 7.5) with non-insertional tendinopathy of the subscapularis treated arthroscopically were retrospectively reviewed. All patients had anterior shoulder pain with no weakness during belly-press testing and no subscapularis footprint involvement on magnetic resonance imaging. All patients were managed with subscapularis tendon debridement and side-to-side repair along with treatment of concomitant pathology. RESULTS: Seven patients had a Type I lesion (so-called Conrad lesion) – a nodule on the leading edge of the subscapularis. Eighteen patients had a Type II lesion – a visible split tear with degeneration in the upper ½ of the intra-articular tendon. Nine patients had a Type III lesion – more extensive splitting in the tendon with advanced tendon degeneration. At a mean follow-up of 24 months, 97% of patients were completely satisfied. Significant improvements were seen in forward elevation (152 ± 12° to 172 ± 5°, P < 0.001) and visual analog scale pain scores (5.9 ± 1.7-0.6 ± 1.0, P < 0.001). Internal rotation strength and external rotation motion at the side were maintained. ASES scores averaged 95.4 ± 7.4, disabilities of arm, shoulder and hand scores averaged 6.19 ± 9.8, Western Ontario Rotator Cuff scores averaged 91.7 ± 9.3 and the average University of California at Los Angeles score was 33.1 ± 2.4. CONCLUSIONS: We present a previously unreported finding of the subscapularis, the Conrad lesion, along with a novel classification system for non-insertional tendinopathy of the subscapularis. Arthroscopic treatment of this spectrum of tendinopathy along with concomitant shoulder pathology eliminated pain and improved patient outcomes without detrimental effects. LEVEL OF EVIDENCE: IV, Retrospective Case Series. Medknow Publications & Media Pvt Ltd 2013 /pmc/articles/PMC3807950/ /pubmed/24167399 http://dx.doi.org/10.4103/0973-6042.118876 Text en Copyright: © International Journal of Shoulder Surgery http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Dierckman, Brian D.
Shah, Nirav R.
Larose, Connor R.
Gerbrandt, Stacey
Getelman, Mark H.
Non-insertional tendinopathy of the subscapularis
title Non-insertional tendinopathy of the subscapularis
title_full Non-insertional tendinopathy of the subscapularis
title_fullStr Non-insertional tendinopathy of the subscapularis
title_full_unstemmed Non-insertional tendinopathy of the subscapularis
title_short Non-insertional tendinopathy of the subscapularis
title_sort non-insertional tendinopathy of the subscapularis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3807950/
https://www.ncbi.nlm.nih.gov/pubmed/24167399
http://dx.doi.org/10.4103/0973-6042.118876
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