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Purpose Early repair of rotator cuff tears leads to superior results. To detect symptomatic full-thickness tears of the supraspinatus tendon at an early stage, we conducted a prospective study to evaluate the value of clinical examination with and without subacromial lidocaine within the first weeks after an acute injury to the shoulder. Methods Of 104 patients included in a prospective investigation, 52 patients were selected to evaluate the diagnostic accuracy of clinical tests in acute full-thickness tears of the supraspinatus tendon. Clinical tests and ultrasound examination were performed at a median of 13 days (range, 3 to 49 days) after the initial injury. The study group consisted of 29 patients (median age, 56 years [range, 39 to 75 years]) who all had an acute complete tear of the supraspinatus tendon verified by ultrasound and arthroscopy. The control group consisted of 23 patients who all had an intact tendon confirmed by ultrasound (median age, 38 years [range, 19 to 73 years]). Results The Hawkins sign (0.83) and the painful arc test (0.97) had high sensitivity but low specificity (0.23 and 0.05, respectively). The external rotation lag sign (ERLS) and the drop-arm test (DAT) had a sensitivity of 0.39 and 0.37, respectively, and specificity of 0.91 and 0.86, respectively, in diagnosing acute full-thickness tears of the rotator cuff. After a subacromial lidocaine injection, sensitivity of all lag sign tests was reduced, whereas specificity and likelihood ratios of the Jobe test, the ERLS, and the DAT improved. Active abduction was significantly reduced in the full-thickness tear group. Conclusions A positive lag sign (ERLS or DAT) is indicative of a full-thickness supraspinatus tear, but a negative lag sign does not preclude a tear. After a subacromial injection of lidocaine, the specificity improves whereas the sensitivity is reduced. Overall, in patients with suspected acute rotator cuff tear, clinical tests cannot stand alone in the evaluation the first weeks after an acute injury. Level of Evidence Level I, diagnostic study—testing of previously developed criteria in a series of consecutive patients (by use of arthroscopy and ultrasound as the gold standard).

The aim of this study was to evaluate the epidemiologic data of patients with an acute soft-tissue injury to the shoulder, with an emphasis on improving the early diagnosis of acute rotator cuff tears. This study included 104 patients, with a median age of 49 years (range, 19-75 years). The patients were evaluated clinically and with ultrasonography at a median of 13 days (range, 3-49 days) after the injury. A total of 60 patients (58%) had some degree of cuff lesion on the ultrasonographic examination. Of these patients, 33 (32%) had a full-thickness rotator cuff tear, 14 (13%) had a partial-thickness cuff tear in the tendon substance, and 13 (13%) had a partial cuff tear at the insertion site on the major tubercle. The injury mechanism or activity at the moment of injury did not correlate with the presence of a rotator cuff lesion, but we found a strong age correlation, with a prevalence of any rotator cuff tear, above 50%, for patients aged above 50 years and with a prevalence of full-thickness tears of 50% in the groups aged 50 to 59 years and aged 60 to 69 years. In conclusion, this study found a high incidence of rotator cuff lesions by further evaluation of patients undergoing consultation at the emergency department, with an inability to perform active abduction above 90 degrees and normal radiographs, after an acute shoulder trauma.

Objective: In this prospective study, we established and evaluated an ultrasound technique to demonstrate anterior passive translation of the shoulder, using a new anterior approach. Methods: A preliminary in vitro study was performed, with anterior ultrasound scanning of a skeleton in a waterbath. Forty shoulders in twenty normal subjects were then examined with a 3.5 MHz linear transducer, using the same anterior approach. The anterior range of motion (ROM) was measured during passive anterior translation. Results: Anatomical landmarks were identified anteriorly on the humerus and the scapula, to define a scanning plane, in which ROM was measured to 1.8 ± 0.1 mm (mean ± S.E.M.) (range 0.4–4.1 mm). The difference in ROM between the two shoulders of each subject (Δ ROM) was calculated: 0.7 ± 0.1 mm (range 0.1–1.9 mm). Conclusion: The anterior translation of the shoulder can be assessed objectively, non-invasively and rapidly by ultrasonography. We found ROM to be less than 4 mm, and A ROM to be less than 2 mm. The interobserver variability of the method remains to be investigated, as is its usefulness in the diagnosis of chronic anterior shoulder instability.

A new method for measuring the anterior translation in the shoulder joint by dynamic ultrasound was evaluated. We placed a 3.5-MHz transducer on the shoulder anteriorly. By using 3 bony landmarks, we then measured the anterior translation of the humeral head with a force of 90 N applied posteriorly. We performed such measurements in 20 subjects with healthy shoulders and in 20 patients with unilateral shoulder instability. There was a mean translation of 1.9 mm in healthy shoulders and 4.9 mm in unstable shoulders (P < .01). The mean difference between the 2 sides in subjects with normal shoulders was 0.7 mm, whereas the mean difference in patients with instability was 2.8 mm (P < .01). The normal shoulders were examined by 2 examiners to determine the degree to which different examiners' measurements might vary. Although one examiner recorded higher values than the other, the new method seems suitable for measuring increased laxity in unstable shoulders.

Adverse effects of perioperative blood transfusion appear to be storage-time-dependent and may be related to extracellular accumulation of bioactive substances in blood products. In this study the clinical effects of leukofiltered and non-filtered blood products in patients undergoing surgery for burn trauma are investigated. 24 consecutive patients were randomly selected to receive transfusion with non-filtered blood components (group A, n = 12) or similar products, which were prestorage leukofiltered (group B, n = 12). The burn injury was scored using the Bull and Fischer index of age and burn surface area. Histamine, interleukin-6 (IL-6), plasminogen activator inhibitor-1 (PAI-1), eosinophil cationic protein (ECP) and myeloperoxidase (MPO) were analysed in plasma or serum collected from all patients 30 min before skin incision, at skin incision and 5, 10 and 30 min and thereafter every 30 min after skin incision until the grafts were secured by wrapping. Samples were also taken 8 h after skin incision and in the morning of postoperative days 1-5. The amount of blood products transfused from admission until day 5 postoperatively was recorded. All patients were followed until discharge or death. The Bull and Fischer index was comparable in the two groups. Prestorage leukofiltration reduced the amount of blood products required for transfusion significantly (p < 0.05) compared with non-filtered products. The levels of the various bioactive substances changed during and after the operation. In particular, ECP and MPO levels increased significantly (p < 0.05) in group A patients compared with unchanged (ECP) or decreased (MPO) levels in group B patients. IL-6 analyses showed, that the trauma had more severe impact on group B patients than on group A patients. Nevertheless, 4 patients died in group A and 2 in group B; all with a Bull and Fischer index between 1.0 and 2.0. Prestorage leukocyte filtration may reduce transfusion related accumulation of various bioactive substances and the requirement for blood in burn trauma patients.