Scapula dyskinesis in medium-sized full-thickness rotator cuff tear after subacromial Lidocaine infiltration and rotator cuff reconstruction

IF 2.7 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2025-02-06 DOI:10.1002/jeo2.70154

Zoltán Nyőgér, Csenge A. Molnár, Norbert Szakály, Anna Várnagy, Tamás Terebessy, Tibor Gunther, Gábor Skaliczki

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Abstract

Purpose

In rotator cuff tears, scapular dyskinesis is often observed. The aim of our study is to better understand the cause and the role of scapular dyskinesis in rotator cuff tears and evaluate changes in scapulothoracic kinematics after Lidocaine subacromial injection and surgery in patients with medium-sized (1–3 cm) rotator cuff tear.

Methods

The scapular motion during humerus sagittal flexion of nine healthy persons (healthy group, HG) and nine persons with a medium-sized rotator cuff tear (surgery group, SG) was investigated using the VICON motion capture system and upper limb evaluation in movement analysis software. In addition, quality of life and functional outcomes were assessed in the SG group using American Shoulder and Elbow Surgeons, Oxford and Constant-Murley scores and rotator muscle force and Visual Analogue Scale score were evaluated. The SG was further divided into three subgroups: measurements were performed preoperatively (before surgery native subgroup—BSN), then after subacromial Lidocaine injection (before surgery injection subgroup—BSI) and 6 months after rotator cuff reconstruction (after surgery subgroup—AS). Changes observed after injection (BSI) and surgery (AS) were compared to the BSN.

Results

In the BSI, a significant reduction (p < .025) in protraction was observed in the raising phase between 20° and 70° comparing it to the BSN, protraction decreased by 5.3° ± 7.9° (mean ± standard deviation [SD]). In the lowering phase between 80° and 30°, we registered a decrease of protraction by 6.0° ± 8.3° (mean ± SD). In the AS, we observed an approximation of protraction to the HG, but no significant change was detected.

Conclusion

Significant reduction in scapular protraction was demonstrated with Lidocaine subacromial injection during both the arm raising and lowering phases. Six months of rehabilitation treatment in the postoperative period is not enough to fully eliminate scapular dyskinesis.

Level of Evidence

Level II.

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肩峰下利多卡因浸润和肩袖重建后中型全层肩袖撕裂的肩胛骨运动障碍

目的在肩袖撕裂中，经常观察到肩胛骨运动障碍。我们研究的目的是为了更好地了解肩胛骨运动障碍在肩袖撕裂中的原因和作用，并评估中型（1-3厘米）肩袖撕裂患者肩胛骨下注射利多卡因和手术后肩胛骨胸椎运动学的变化。方法采用VICON运动捕捉系统和上肢运动分析软件对9例正常人（健康组，HG）和9例中型肩袖撕裂患者（手术组，SG）在肱骨矢状位屈曲时的肩胛骨运动进行研究。此外，使用American Shoulder and肘部外科医生评估SG组的生活质量和功能结果，牛津评分和Constant-Murley评分以及旋转肌力和视觉模拟量表评分进行评估。SG进一步分为三个亚组：术前（术前原生亚组bsn）、肩峰下利多卡因注射后（术前注射亚组bsi）和肩袖重建后6个月（术后亚组as）进行测量。将注射（BSI）和手术（AS）后观察到的变化与BSN进行比较。结果与BSN相比，BSI在20°~ 70°的抬高阶段的俯仰明显减少（p < 0.025），俯仰减少5.3°±7.9°（mean±standard deviation [SD]）。在80°和30°之间的降低阶段，我们记录到拉伸减少了6.0°±8.3°（平均值±SD）。在AS中，我们观察到HG的近似延长，但未检测到显著变化。结论利多卡因肩峰下注射在上臂和下臂阶段均能明显减少肩胛骨外伸。术后6个月的康复治疗不足以完全消除肩胛骨运动障碍。证据等级二级。

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