Rotator Cuff Partial Thickness Tears - Mark Falworth 24/4/2001Neer ('83 Clin Orthop) : Impingement divided into three stages; I - Haemorrhage and oedema II - Fibrosis and tendinitis III - Tearing of the rotator cuff Stage I and II lesions often respond to non-operative treatment including physio / NSAID's / corticosteroid injections. Stage III lesions are less precisely managed. Neer ('72 “ JBJS) proposed open anterior acromioplasty for chronic impingement syndrome based on a theory, later termed The ExtrinsicTheory, that impingment was secondary to acromial morphology. Bigliani ('86 & '87 Orthop Trans) defined acromial morphology as I - Flat II - Curved III - Hooked with 80% of full thickness tears being attributed to Type III lesions and 20% to Type II lesions.
Conversely
The Intrinsic Theory
suggests that impingement is a secondary phenomena due to superior migration of the humeral head due to a weakened / injured rotator cuff. The cuff is then further damaged by the acromion leading to an impingement lesion or tear of the cuff
.(Budoff ' 98 JBJS)
Partial thickness tears may be Bursal side, Joint side or Intratendinous. Diagnosis is based on arthroscopic findings, MRI, and US . Intratendinous tears are obviously the most difficult to diagnosis and are easily missed.
Kempf, Weber
and Yamanaka are the Big Three always quoted at meetings.
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