Partial Thickness Rotator Cuff Tears of the Shoulder Related to the Sports / 대한정형외과학회잡지

A painful shoulder is common among athletes, particularly those involved in overhead throwing. Professional and recreational athletes in throwing activities have an increased risk of partial thickness tears of the rotator cuff. The manuscript was to reviews the literature on the characteristics of injury, treatment strategies, and their results in throwing athletes.

Comparisons of the Various Partial-Thickness Rotator Cuff Tears on MR Arthrography and Arthroscopic Correlation

OBJECTIVE: To assess the diagnostic performance of MR arthrography in the diagnosis of the various types of partial-thickness rotator cuff tears by comparing the MR imaging findings with the arthroscopic findings. MATERIALS AND METHODS: The series of MR arthrography studies included 202 patients consisting of 100 patients with partial-thickness rotator cuff tears proved by arthroscopy and a control group of 102 patients with arthroscopically intact rotator cuffs, which were reviewed in random order. At arthroscopy, 54 articular-sided, 26 bursal-sided, 20 both articular- and bursal-sided partial-thickness tears were diagnosed. The MR arthrographies were analyzed by two radiologists for articular-sided tears, bursal-sided tears, and both articular- and bursal-sided tears of the rotator cuff. The sensitivity and specificity of each type of partial-thickness tears were determined. Kappa statistics was calculated to determine the inter- and intra-observer agreement of the diagnosis of partial-thickness rotator cuff tears. RESULTS: The sensitivity and specificity of the various types of rotator cuff tears were 85% and 90%, respectively for articular-sided tears, 62% and 95% for bursal-sided tears, as well as 45% and 99% for both articular- and bursal-sided tears. False-negative assessments were primarily observed in the diagnosis of bursal-sided tears. Conversely, both articular- and bursal-sided tears were overestimated as full-thickness tears. Inter-observer agreement was excellent for the diagnosis of articular-sided tears (k = 0.70), moderate (k = 0.59) for bursal-sided tears, and fair (k = 0.34) for both articular- and bursal-sided tears, respectively. Intra-observer agreement for the interpretation of articular- and bursal-sided tears was excellent and good, respectively, whereas intra-observer agreement for both articular- and bursal-sided tears was moderate. CONCLUSION: MR arthrography is a useful diagnostic tool for partial-thickness rotator cuff tears, but has limitations in that it has low sensitivity in bursal- and both articular- and bursal-sided tears. In addition, it shows only fair inter-observer agreement when it comes to predicting both articular- and bursal-sided tears.

Comparative Study of MR-arthrography and Arthroscopy in Partial Thickness Rotator Cuff Tears

PURPOSE: The purpose of this study was to assess the efficacy of MR arthrography to detect partial thickness rotator cuff tears. MATERIALS AND METHODS: One hundred and seventy seven patients with a high suspicion for rotator cuff disease were studied by performing MR-arthrography and subsequent arthroscopy. The ability of MRarthrography to detect partial thickness tears was evaluated according to the location of the tears. We determined the correspondence between the measurements of the articular side partial tears on MR arthrography and those on the arthroscopic findings. RESULTS: The arthroscopic diagnosis of partial thickness rotator cuff tears was divided into 3 groups according to their location. There were 63 cases on the articular side, 41 cases on the bursal side and 20 cases on both sides. The sensitivity of MR-arthrography was 82% for the articular side tears and 11% for the bursal tears. The specificity was 88% for the articular side tears and 100% for the bursal tears. MRarthrographic measurement correctly predicted 72% in 28 repaired cases of 56 articular side partial thickness tears. CONCLUSIONS: MR-arthrography may be a reliable tool for diagnosing articular side partial thickness rotator cuff tears, but it has limitations for bursal side tears.

Clinical Features and Arthroscopic Findings of Partial Thickness Rotator Cuff Tears / 대한정형외과학회잡지

PURPOSE: To compare the clinical features of partial thickness rotator cuff tears according to location of the tear and to classify the partial thickness rotator cuff tears based on arthroscopic findings. MATERIALS AND METHODS: This study evaluated 138 patients who were arthroscpically proven to be partial thickness rotator cuff tears. Three groups were identified; 56 in the articular side tear, 58 in the bursal side tear, 24 in the both sides tear. The comparison included preoperative clinical features such as pain, range of motion and impingement sign. The partial thickness rotator cuff tears were classified according to the arthroscopic findings. RESULTS: There was no significant difference in the clinical features between articular, bursal and both sides tears. Partial thickness rotator cuff tear can be divided into 5 groups. Type I (n=41): fraying or fibrillation on surface of the cuff. Type II (n=35): fiber disruptions with or without displacement. Type III (n=38): flap tear or fragmentation. Type IV (n=16): both articular and bursal side tears without communications. Type V (n=8): impending a full thickness tear. CONCLUSION: It is difficult to differentiate the clinical features based on the physical examinations according to the locations of tears. Newly designed classification may help in deternmining the appropriate arthroscopic treatment of a partial thickness rotator cuff tear.

Partial Thickness Tear of the Deep Surface of the Subscapularis Tendon: Its Relationship to the Anterior Internal Impingement / 대한정형외과학회잡지

PURPOSE: The purposes of this study were to investigate the relationship between partial thickness articular side tear of the subscapularis tendon and anterior internal impingement, and to evaluate the clinical outcomes. MATERIALS AND METHODS: We reviewed 27 cases who underwent surgery for tears in the deep surface of the subscapularis tendon. On arthroscopic examination, fraying or tear less than 10% thickness of the subscapularis tendon was observed in 9 cases, 10-30% in 5, more than 30% in 5, and longitudinal tear in 8. Tears were treated with debridement only in 21 cases, arthroscopic repair in 5, and open repair in 1. Labral or SLAP repair was also performed in 6 cases. Analysis was done by the preoperative clinical test, coracoid index and coracohumeral distance from the MR images, associated lesion and the presence or absence of anterior internal impingement on arthroscopic evaluation. Clinical results were assessed using the University of California at Los Angeles shoulder rating scale. RESULTS: Anterior labral lesions were present in 59% of the cases. Hawkins test was positive in 16 cases (59%). Among these cases, labral lesions were seen in 14 (88%). The results were satisfactory in 81%. CONCLUSION: We thought that anterior internal impingement between the partial thickness tear of the subscapularis tendon and the anterior glenoid labrum may cause shoulder pain and possibly induce progression of tear in deep surface of the subscapularis tendon, and Hawkins test is helpful for diagnosis. Satisfactory outcomes could be obtained with debridement or repair in partial tear of the deep surface of the subscapularis tendon.