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Partial-Thickness Rotator Cuff Tears

  • Rachel M. FrankEmail author
  • Jas Chahal
  • Nikhil N. Verma
Chapter

Abstract

Rotator cuff repair is one of the most common procedures performed in orthopedic surgery. The goal of repair is to restore normal rotator cuff kinematics in an effort to improve glenohumeral function and reduce pain. Recent data has revealed that healing and anatomic integrity of the rotator cuff repair site correlates with improved outcomes, particularly with regard to strength and functional recovery. Rotator cuff pathology exists on a wide spectrum that ranges from cuff tendon edema and inflammation to partial- and full-thickness tears of one or more of the cuff tendons. Recent advances in diagnostic imaging modalities have led to an increase in clinician recognition of partial-thickness rotator cuff tears. As elegantly described by Clark and Harryman (J Bone Joint Surg 74A:713–725, 1992), the anatomy of the rotator cuff insertion onto the humerus is complex as the tendons, articular capsule, coracohumeral ligament (CHL), and glenohumeral ligament complex essentially blend to form a confluent, layered sheet prior to insertion onto the tuberosities.

Keywords

Rotator Cuff Rotator Cuff Tear Great Tuberosity Magnetic Resonance Arthrography Subacromial Space 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Rajaram A, et al. Partial articular-sided rotator cuff tears: a comparative study of in-situ repair vs completion of tear prior to repair. In: American Orthopaedic Society for Sports Medicine 2012 annual meeting, Baltimore, 2012.Google Scholar
  2. 2.
    Cole BJ, McCarty 3rd LP, Kang RW, Alford W, Lewis PB, Hayden JK. Arthroscopic rotator cuff repair: prospective functional outcome and repair integrity at minimum 2-year follow-up. J Shoulder Elbow Surg. 2007;16:579–85.PubMedCrossRefGoogle Scholar
  3. 3.
    DeFranco MJ, Bershadsky B, Ciccone J, Yum JK, Iannotti JP. Functional outcome of arthroscopic rotator cuff repairs: a correlation of anatomic and clinical results. J Shoulder Elbow Surg. 2007;16:759–65.PubMedCrossRefGoogle Scholar
  4. 4.
    Flurin PH, Landreau P, Gregory T, Boileau P, Brassart N, Courage O, et al. Arthroscopic repair of full-thickness cuff tears: a multicentric retrospective study of 576 cases with anatomical assessment. Rev Chir Orthop Reparatrice Appar Mot. 2005;91:31–42.PubMedCrossRefGoogle Scholar
  5. 5.
    Wilson FV, Hinov V, Adams G. Arthroscopic repair of full-thickness tears of the rotator cuff: 2- to 14-year follow-up. Arthroscopy. 2002;18:136–44.PubMedCrossRefGoogle Scholar
  6. 6.
    Harryman 2nd DT, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen 3rd FA. Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg. 1991;73A:982–9.Google Scholar
  7. 7.
    Matava MJ, Purcell DB, Rudzki JR. Partial-thickness rotator cuff tears. Am J Sports Med. 2005;33:1405–17.PubMedCrossRefGoogle Scholar
  8. 8.
    McConville OR, Iannotti JP. Partial-thickness tears of the rotator cuff: evaluation and management. J Am Acad Orthop Surg. 1999;7:32–43.PubMedGoogle Scholar
  9. 9.
    Wolff AB, Sethi P, Sutton KM, Covey AS, Magit DP, Medvecky M. Partial-thickness rotator cuff tears. J Am Acad Orthop Surg. 2006;14:715–25.PubMedGoogle Scholar
  10. 10.
    Clark JM, Harryman 2nd DT. Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. J Bone Joint Surg. 1992;74A:713–25.Google Scholar
  11. 11.
    Strauss EJ, Salata MJ, Kercher J, Barker JU, McGill K, Bach Jr BR, et al. Multimedia article. The arthroscopic management of partial-thickness rotator cuff tears: a systematic review of the literature. Arthroscopy. 2011;27:568–80.PubMedCrossRefGoogle Scholar
  12. 12.
    Ellman H. Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res. 1990;254:64–74.PubMedGoogle Scholar
  13. 13.
    Dugas JR, Campbell DA, Warren RF, Robie BH, Millett PJ. Anatomy and dimensions of rotator cuff insertions. J Shoulder Elbow Surg. 2002;11:498–503.PubMedCrossRefGoogle Scholar
  14. 14.
    Snyder SJ, Pachelli AF, Del Pizzo W, Friedman MJ, Ferkel RD, Pattee G. Partial thickness rotator cuff tears: results of arthroscopic treatment. Arthroscopy. 1991;7:1–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Conway JE. Arthroscopic repair of partial-thickness rotator cuff tears and SLAP lesions in professional baseball players. Orthop Clin North Am. 2001;32:443–56.PubMedCrossRefGoogle Scholar
  16. 16.
    Lohr JF, Uhthoff HK. The pathogenesis of degenerative rotator cuff tears. Orthop Trans. 1987;11:237.Google Scholar
  17. 17.
    Fukuda H. Partial-thickness rotator cuff tears: a modern view on Codman’s classic. J Shoulder Elbow Surg. 2000;9:163–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Fukuda H, Mikasa M, Yamanaka K. Incomplete thickness rotator cuff tears diagnosed by subacromial bursography. Clin Orthop Relat Res. 1987;223:51–8.PubMedGoogle Scholar
  19. 19.
    Codman EA. The shoulder: rupture of the supraspinatus tendon and other lesions in or about the sub-acromial bursa. Boston: Miller & Medical; 1934.Google Scholar
  20. 20.
    Payne LZ, Altchek DW, Craig EV, Warren RF. Arthroscopic treatment of partial rotator cuff tears in young athletes. A preliminary report. Am J Sports Med. 1997;25:299–305.PubMedCrossRefGoogle Scholar
  21. 21.
    Lohr JF, Uhthoff HK. The microvascular pattern of the supraspinatus tendon. Clin Orthop Relat Res. 1990;254:35–8.PubMedGoogle Scholar
  22. 22.
    Chandnani V, Ho C, Gerharter J, Neumann C, Kursunoglu-Brahme S, Sartoris DJ, et al. MR findings in asymptomatic shoulders: a blind analysis using symptomatic shoulders as controls. Clin Imaging. 1992;16:25–30.PubMedCrossRefGoogle Scholar
  23. 23.
    Connor PM, Banks DM, Tyson AB, Coumas JS, D’Alessandro DF. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study. Am J Sports Med. 2003;31:724–7.PubMedGoogle Scholar
  24. 24.
    Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg. 1995;77A:10–5.Google Scholar
  25. 25.
    Miniaci A, Dowdy PA, Willits KR, Vellet AD. Magnetic resonance imaging evaluation of the rotator cuff tendons in the asymptomatic shoulder. Am J Sports Med. 1995;23:142–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Ozaki J, Fujimoto S, Nakagawa Y, Masuhara K, Tamai S. Tears of the rotator cuff of the shoulder associated with pathological changes in the acromion. A study in cadavera. J Bone Joint Surg. 1988;70A:1224–30.Google Scholar
  27. 27.
    Liu SH, Baker CL. Arthroscopically assisted rotator cuff repair: correlation of functional results with integrity of the cuff. Arthroscopy. 1994;10:54–60.PubMedCrossRefGoogle Scholar
  28. 28.
    Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg. 2004;86A:219–24.Google Scholar
  29. 29.
    Gerber C, Meyer DC, Frey E, von Rechenberg B, Hoppeler H, Frigg R, et al. Neer Award 2007: reversion of structural muscle changes caused by chronic rotator cuff tears using continuous musculotendinous traction. An experimental study in sheep. J Shoulder Elbow Surg. 2009;18:163–71.PubMedCrossRefGoogle Scholar
  30. 30.
    Coleman SH, Fealy S, Ehteshami JR, MacGillivray JD, Altchek DW, Warren RF, et al. Chronic rotator cuff injury and repair model in sheep. J Bone Joint Surg. 2003;85A:2391–402.Google Scholar
  31. 31.
    Baumgarten KM, Gerlach D, Galatz LM, Teefey SA, Middleton WD, Ditsios K, et al. Cigarette smoking increases the risk for rotator cuff tears. Clin Orthop Relat Res. 2009;468:1534–41.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA. The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg. 2006;88A:1699–704.CrossRefGoogle Scholar
  33. 33.
    Gazzola S, Bleakney RR. Current imaging of the rotator cuff. Sports Med Arthrosc. 2011;19:300–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Brenneke SL, Morgan CJ. Evaluation of ultrasonography as a diagnostic technique in the assessment of rotator cuff tendon tears. Am J Sports Med. 1992;20:287–9.PubMedCrossRefGoogle Scholar
  35. 35.
    van Holsbeeck MT, Kolowich PA, Eyler WR, Craig JG, Shirazi KK, Habra GK, et al. US depiction of partial-thickness tear of the rotator cuff. Radiology. 1995;197:443–6.PubMedGoogle Scholar
  36. 36.
    Yen CH, Chiou HJ, Chou YH, Hsu CC, Wu JJ, Ma HL, et al. Six surgery-correlated sonographic signs for rotator cuff tears: emphasis on partial-thickness tear. Clin Imaging. 2004;28:69–76.PubMedCrossRefGoogle Scholar
  37. 37.
    Wiener SN, Seitz Jr WH. Sonography of the shoulder in patients with tears of the rotator cuff: accuracy and value for selecting surgical options. AJR Am J Roentgenol. 1993;160:103–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Co S, Bhalla S, Rowan K, Aippersbach S, Bicknell S. Comparison of 2- and 3-dimensional shoulder ultrasound to magnetic resonance imaging in a community hospital for the detection of supraspinatus rotator cuff tears with improved worktime room efficiency. Can Assoc Radiol J. 2012;63:170–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Sipola P, Niemitukia L, Kröger H, Höfling I, Väätäinen U. Detection and quantification of rotator cuff tears with ultrasonography and magnetic resonance imaging – a prospective study in 77 consecutive patients with a surgical reference. Ultrasound Med Biol. 2010;36:1981–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Al-Shawi A, Badge R, Bunker T. The detection of full thickness rotator cuff tears using ultrasound. J Bone Joint Surg. 2008;90B:889–92.CrossRefGoogle Scholar
  41. 41.
    Ok JH, Kim YS, Kim JM, Yoo TW. Learning curve of office-based ultrasonography for rotator cuff tendons tears. Knee Surg Sports Traumatol Arthrosc. 2013;21:1593–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Smith TO, Back T, Toms AP, Hing CB. Diagnostic accuracy of ultrasound for rotator cuff tears in adults: a systematic review and meta-analysis. Clin Radiol. 2011;66:1036–48.PubMedCrossRefGoogle Scholar
  43. 43.
    Smith TO, Daniell H, Geere JA, Toms AP, Hing CB. The diagnostic accuracy of MRI for the detection of partial- and full-thickness rotator cuff tears in adults. Magn Reson Imaging. 2012;30:336–46.PubMedCrossRefGoogle Scholar
  44. 44.
    Yamakawa S, Hashizume H, Ichikawa N, Itadera E, Inoue H. Comparative studies of MRI and operative findings in rotator cuff tear. Acta Med Okayama. 2001;55:261–8.PubMedGoogle Scholar
  45. 45.
    Schaeffeler C, Mueller D, Kirchhoff C, Wolf P, Rummeny EJ, Woertler K. Tears at the rotator cuff footprint: prevalence and imaging characteristics in 305 MR arthrograms of the shoulder. Eur Radiol. 2011;21:1477–84.PubMedCrossRefGoogle Scholar
  46. 46.
    Angelo RL. Chapter 19: Partial-thickness rotator cuff tears. In: Angelo RL, Esch JC, Ryu RKN, editors. AANA advanced arthroscopy: the shoulder. Philadelphia: Saunders/Elsevier; 2010. p. 188–98.Google Scholar
  47. 47.
    Drakos MC, Rudzki JR, Allen AA, Potter HG, Altchek DW. Internal impingement of the shoulder in the overhead athlete. J Bone Joint Surg. 2009;91A:2719–28.CrossRefGoogle Scholar
  48. 48.
    Heyworth BE, Williams 3rd RJ. Internal impingement of the shoulder. Am J Sports Med. 2009;37:1024–37.PubMedCrossRefGoogle Scholar
  49. 49.
    Chahal J, Mall N, MacDonald PB, Van Thiel G, Cole BJ, Romeo AA, et al. The role of subacromial decompression in patients undergoing arthroscopic repair of full-thickness tears of the rotator cuff: a systematic review and meta-analysis. Arthroscopy. 2012;28:720–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Ide J, Maeda S, Takagi K. Arthroscopic transtendon repair of partial-thickness articular-side tears of the rotator cuff: anatomical and clinical study. Am J Sports Med. 2005;33:1672–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Duralde XA, McClelland Jr WB. The clinical results of arthroscopic transtendinous repair of grade III partial articular-sided supraspinatus tendon tears. Arthroscopy. 2012;28:160–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Koh KH, Shon MS, Lim TK, Yoo JC. Clinical and magnetic resonance imaging results of arthroscopic full-layer repair of bursal-side partial-thickness rotator cuff tears. Am J Sports Med. 2011;39:1660–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Wright SA, Cofield RH. Management of partial-thickness rotator cuff tears. J Shoulder Elbow Surg. 1996;5:458–66.PubMedCrossRefGoogle Scholar
  54. 54.
    Weber SC. Arthroscopic debridement and acromioplasty versus mini-open repair in the management of significant partial-thickness tears of the rotator cuff. Orthop Clin North Am. 1997;28:79–82.PubMedCrossRefGoogle Scholar
  55. 55.
    Deutsch A. Arthroscopic repair of partial-thickness tears of the rotator cuff. J Shoulder Elbow Surg. 2007;16:193–201.PubMedCrossRefGoogle Scholar
  56. 56.
    Brockmeier SF, Dodson CC, Gamradt SC, Coleman SH, Altchek DW. Arthroscopic intratendinous repair of the delaminated partial-thickness rotator cuff tear in overhead athletes. Arthroscopy. 2008;24:961–5.PubMedCrossRefGoogle Scholar
  57. 57.
    Shin SJ. A comparison of 2 repair techniques for partial-thickness articular-sided rotator cuff tears. Arthroscopy. 2012;28:25–33.PubMedCrossRefGoogle Scholar
  58. 58.
    Kim KC, Shin HD, Cha SM, Park JY. Clinical outcomes after arthroscopic trans-tendon suture-bridge technique in partial-thickness articular-side rotator cuff tear. Knee Surg Sports Traumatol Arthrosc. 2013;21:1183–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Weber SC. Arthroscopic debridement and acromioplasty versus mini-open repair in the treatment of significant partial-thickness rotator cuff tears. Arthroscopy. 1999;15(2):126–31.Google Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Rachel M. Frank
    • 1
    Email author
  • Jas Chahal
    • 1
  • Nikhil N. Verma
    • 1
  1. 1.Department of Orthopaedic SurgeryRush University Medical CenterChicagoUSA

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