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Rotator Cuff Tears: Partial Rotator Cuff Tear


- Discussion:
    - rotator cuff anatomy
    - frequency of tear
    - diff dx of cuff tears
    - etilogy of tear:
            - impingement syndrome: (75%)
            - shoulder instability (anterior or multi-directional) (15%) (should be considered in any young active patient);
            - trauma:
                   - occurs in 10% of patients;
                   - note that a displaced greater tuberosity frx is a RTC tear equivolent;
    - by definition, partial tears involve 50% or more of the tendon;
    - in the study by Weber SC (1999), 32 patients with significant partial-thickness rotator cuff tears were treated with debridement and acromioplasty versus 33 patients who were with mini-open repair;
            - 88% of tears were on the articular sidee;
            - acromiplasty and debridement group:
            - significant number of the arthroscopic group had fair results by UCLA score criteria;
            - 3 patients reruptured the remaining cuff later despite adequate acromioplasty;
            - healing of the partial tear was never observed at second-look arthroscopy;
            - acromioplasty alone did not prophylactically prevent rotator cuff tear progression;
            - the good results of arthroscopic treatment of significant partial-thickness tears deteriorated with time;
            - open repair group:
            - although postoperative pain was significantly greater and recovery slower with open repair, no patient was reoperated on and rerupture of the repair did not occur;

- Shoulder Exam:
    - impingement sign and test:
    - it is essential to document ROM deficits, since rotator cuff repair would not be expected to yield a good outcome in the face of fixed shoulder contractures;

- Radiographic Findings:
    - scapular outlet view
    - 30 deg caudal tilt view AP view
    - arthrography
    - MRI of Shoulder: Coronal Oblique View of Shoulder


- Surgical Treatment:
    - arthroscopy (arthroscopic acromioplasty) followed by rotator cuff repair
           - allows accurate assesment of rotator cuff tear;
           - look for hypervascularity at the base of the biceps tendon as well as fraying of the cuff just lateral to the biceps tendon;
           - does not require elevation of the deltoid off the acromioplasty;
           - allows a more lateral incision, directly over the rotator cuff tear, (avoid deltoid detachment);
           - ref: Débridement of Partial-Thickness Tears of the Rotator Cuff without Acromioplasty. Long-Term Follow-up and Review of the Literature
    - open rotator cuff repair
    - arthroscopic rotator cuff repair 

- References

Tears of the rotator cuff of the shoulder associated with pathological changes in the acromion. A study in cadavera.  

Arthroscopic Debridement and Acromioplasty Versus Mini-Open Repair in the Treatment of Significant Partial-Thickness Rotator Cuff Tears.

Transtendon arthroscopic repair of partial-thickness, articular surface tears of the rotator cuff

Partial-thickness Articular Surface Rotator Cuff Tears: an All-inside Repair Technique 

Pasta lesion-trans-tendon technique for repair