Skillful Neglect Vs Repair For Subscapularis Tear Associated With Posterosuperior Cuff Tears Repair.

Study Overview
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Brief Summary
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The purpose of this study is to compare functional outcomes of Skillful Neglect & arthroscopic repair of upper border subscapularis tear in La fosse type 1 and type 2 with biceps tenotomy in non-athletes,30 shoulders subdivided randomly into 2 groups, 15 patients in group 1 (patient treated by skillful neglect with biceps tenotomy) and 15 patients in group 2 (patients treated by arthroscopic repair with biceps tenotomy)

Detailed Description
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patients are randomized chosen then a shoulder arthroscope is done for all patients with biceps tenotomy but in group1 the investigators are neglecting the upper border tears and in group 2 the investigators are repairing upper border tears with anchors then after the procedure is completed the investigators will follow up by ASES score

Official Title
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Skillful Neglect Vs Repair For Upper Border Subscapularis Tear Associated With Posterosuperior Cuff Tears Repair In Non-Athletes: A Randomized Controlled Trial

Conditions
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Subscapularis Muscle Strain

Intervention / Treatment
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* Procedure: skillful neglect Of upper subscapularis tear in Lafosse type 1 and type 2 with long head biceps tenotomy .
* Procedure: arthroscopic repair Of upper subscapularis tear in Lafosse type 1 and type 2 with long head biceps tenotomy .


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with combined upper subscapularis border tear in Lafosse type 1 and type 2. Exclusion Criteria: Glenohumeral arthritis. Patients with other intra-articular pathology like SLAP lesions. Neural damage (Brachial plexus injury). Revision cases. Patient with subscapularis border tear type 3, type 4, and type 5.

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: group 1 (patient treated by skillful neglect with biceps tenotomy)<br>neglect of upper border subscapularis tear and doing biceps tenotomy | Procedure: skillful neglect Of upper subscapularis tear in Lafosse type 1 and type 2 with long head biceps tenotomy .<br>* The following technique will be utilized for confirm isolated or combined upper subscapularis border partial tear conservative treatment which is considered the standard technique. Semisetting position under GA. Standard shoulder arthroscopy with standard portals for RC repair. Inspection of articular surface of rotator cuff and biceps tendon. Bursectomy, visualization of all rotators. Mobilization is done for associated rotator tears by shaver and radiofrequency device. Both preoperative Statistics randomization that is used to determine which case will be repaired and intraoperative loss of tension of the elongated aspect of the tendon are used to confirm diagnosis and treatment of upper subscapularis border tear. Skillful neglect to the tear. Rotator repair technique by RC anchors Biceps Tenotomy will be done in all cases by cutting of LHBT.<br>Procedure: arthroscopic repair Of upper subscapularis tear in Lafosse type 1 and type 2 with long head biceps tenotomy .<br>* The following technique will be utilized for confirm isolated or combined upper subscapularis border partial tear repair which is considered the standard technique. Semisetting position under GA. Standard shoulder arthroscopy with standard portals for RC repair. Inspection of articular surface of rotator cuff and biceps tendon. Bursectomy, visualization of all rotators. Mobilization is done for associated rotator tears by shaver and radiofrequency device. Both preoperative Statistics randomization that is used to determine which case will be repaired and intraoperative loss of tension of the elongated aspect of the tendon are used to confirm diagnosis and treatment of upper subscapularis border tear. Skillful neglect to the tear. Rotator repair technique by RC anchors Biceps Tenotomy will be done in all cases by cutting of LHBT.<br>|
| Active Comparator: group 2 (patient treated by arthroscopic repair with biceps tenotomy)<br>repair of upper border subscapularis tear and doing biceps tenotomy | Procedure: skillful neglect Of upper subscapularis tear in Lafosse type 1 and type 2 with long head biceps tenotomy .<br>* The following technique will be utilized for confirm isolated or combined upper subscapularis border partial tear conservative treatment which is considered the standard technique. Semisetting position under GA. Standard shoulder arthroscopy with standard portals for RC repair. Inspection of articular surface of rotator cuff and biceps tendon. Bursectomy, visualization of all rotators. Mobilization is done for associated rotator tears by shaver and radiofrequency device. Both preoperative Statistics randomization that is used to determine which case will be repaired and intraoperative loss of tension of the elongated aspect of the tendon are used to confirm diagnosis and treatment of upper subscapularis border tear. Skillful neglect to the tear. Rotator repair technique by RC anchors Biceps Tenotomy will be done in all cases by cutting of LHBT.<br>Procedure: arthroscopic repair Of upper subscapularis tear in Lafosse type 1 and type 2 with long head biceps tenotomy .<br>* The following technique will be utilized for confirm isolated or combined upper subscapularis border partial tear repair which is considered the standard technique. Semisetting position under GA. Standard shoulder arthroscopy with standard portals for RC repair. Inspection of articular surface of rotator cuff and biceps tendon. Bursectomy, visualization of all rotators. Mobilization is done for associated rotator tears by shaver and radiofrequency device. Both preoperative Statistics randomization that is used to determine which case will be repaired and intraoperative loss of tension of the elongated aspect of the tendon are used to confirm diagnosis and treatment of upper subscapularis border tear. Skillful neglect to the tear. Rotator repair technique by RC anchors Biceps Tenotomy will be done in all cases by cutting of LHBT.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| american shoulder elbow score | scale that evaluates two dimensions of shoulder function: pain and performance in activities of daily living. Each of the two domains make up for 50 of the 100 points. | after 6months and 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual analogue score | subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between no pain and worst pain. | Post operative 6months and 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rotator cuff tear