Rotator Cuff Partial Thickness Tears - Mark Falworth 24/4/2001

Neer ('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.


Kempf          Revue de Chirurgie Orthopedique    '93

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