Rotator cuff repair. Long-term results.

OBJECTIVES: To evaluate the results of rotator cuff repair and to look for preoperative and/or intraoperative predictors of long-term outcomes. PATIENTS AND METHODS: All patients who underwent open rotator cuff repair surgery for a full-thickness tear between 1990 and 1996 and who were subsequently followed-up for at least 4 years were contacted. The surgical technique and postoperative rehabilitation program were standardized. We recorded factors potentially associated with outcomes (age, sex, dominant hand, pain, symptom duration, and active range-of-motion limitation). RESULTS: Of the 56 patients identified, 26 men and 24 women with a mean age of 58.52 years were included in the study. Mean symptom duration was 12 months (range, 3-48 months). Before surgery, mean active range of motion of the shoulder was 144.6 degrees for forward elevation, 135.2 degrees for abduction, and 39.4 degrees for lateral rotation with the elbow at the side. The size of the tear measured during surgery was 1-5 cm. Mean time to recovery of shoulder power (75% of the value before the tear) as assessed by the patients was 10 months. After a mean follow-up of 6 years, a significant reduction in pain was noted (from 2.18/3 to 0.98/3; P < 0.001), although two-thirds of the patients reported occasional pain. Six patients were dissatisfied. Range of motion had improved in one-fourth of the patients. Constant's score after surgery was 65/100. Persistent difficulty in taking objects down from high shelves was noted. None of the preoperative or intraoperative factors studied predicted the long-term outcomes. CONCLUSION: In this series of patients, rotator cuff repair reduced pain severity. Nearly a year was needed to achieve the final result. Only a minority of patients experienced an improvement in range of motion.

Suspected gouty tophus in a woman's breast.

A postmenopausal woman treated with diuretics for hypertension and who underwent surgery for a previous fibroadenoma of the left breast presented, in December 2003, with a sudden bloody discharge of the left nipple with local swelling, redness, and pain. Radiologic investigations revealed a well-delimited tumor under the areola. Needle aspiration disclosed many histiocytes but no bacteria. Despite improvement with antibiotics, the tumor was removed. Pathological examination shows features suggesting the tumor was a gouty tophus. Birefringent crystals were retrospectively found on the smears of the aspirated material. To our knowledge, only 3 similar cases have been reported in the literature.

[A practical approach to diagnosing and managing post-menopausal osteoporosis]. / De l'ostéopénie à l'ostéoporose: une approche pragmatique en Rhumatologie.

Postmenopausal osteoporosis is a major challenge in Medicine. From a simple 10 points questionnaire allowing the detection of the main risks of the disease, different treatment options, based on mineral density, are now available. Treatment should be adapted to age and way of life of the patient.