• Clinics in Shoulder and Elbow
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• 제17권4호
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• pp.209-217
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• 2014

Most studies on the pathophysiology, natural history, diagnosis by imaging and outcomes after operative or nonoperative treatment of rotator cuff tear have focused on those of full-thickness tears, resulting in limited knowledge of partial-thickness rotator cuff tears. However, a partial-thickness tear of the rotator cuff is a common disorder and can be the cause of persistent pain and dysfunction of the shoulder joint in the affected patients. Recent updates in the literatures shows that the partial-thickness tears are not merely mild form of full-thickness tears. Over the last decades, an improved knowledge of pathophysiology and surgical techniques of partial-thickness tears has led to more understanding of the significance of this tear and better outcomes. In this review, we discuss the current concept of management for partial-thickness tears in terms of the pathogenesis, natural history, nonoperative treatment, and surgical outcomes associated with the commonly used repair techniques.

• Clinics in Shoulder and Elbow
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• 제5권1호
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• pp.55-62
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• 2002

Purpose : To compare and analyze the results of arthroscopic subacromial decompression and rotator cuff repair between partial rotator cuff tear and complete rotator cuff tear. Material and Methods : The authors studied 42 patients of rotator cuff tear with operation and followed over one year at Dankook university hospital from September, 1998 to March, 2001 The patient average age is 53 years and follow up period is 23 months (12-42mon1hs). We obtained 22 cases in the partial rotator cuff tear group and 20 cases in the complete rotator cuff tear group. In all cases, we used ASES methods to evaluated pain scale and function. Result : In the last follow up patients, the pain scale is decreased from 7.2 to 0.9 (ASES method : 34 to 91) in the partial rotator cuff tear group and from 7.6 to 1.2 (ASES method . 29 to 88) in the complete rotator cuff tear group, but there was no evidence of statistical difference between two groups (P>0.05). The range of motion after operation were increased in two groups. Excellent to good results were obtained 93％ and 95％ patients had pain relief and satisfied function. Conclusion : Arthroscopic subacromial decompression and arthroscopic rotator cuff repair showed good results for both of (ult-thickness and partial thickness rotator cuff tear patients in pain relief and improving the function.

• 대한정형외과 초음파학회지
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• 제6권2호
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• pp.53-59
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• 2013

목적: 회전근 개 환자의 진단에 사용되는 관절 조영술 후 컴퓨터 단층 촬영 (CT arthrography, CTA)과 초음파 검사의 소견을 관절경에서 확인된 결과와 비교하여 두 검사의 진단적 가치를 평가하고자 하였다. 대상 및 방법: 회전근 개 질환으로 의심된 57명에서 CTA를 시행하였고, 이 중 28명에서는 초음파 검사를 동시에 시행하였다. 관절경 소견을 기준으로 하여, 회전근 개의 전 층 및 부분 층 파열에 대한 두 검사의 진단적 가치와 파열 크기에 대한 예측도를 평가하였다. 결과: CTA는 전 층 파열에 대한 민감도가 86.2%, 특이도가 100%, 부분 층 파열에 있어서 민감도는 58.3%, 특이도 87.8%의 결과를 보였다. 초음파 검사는 전 층 파열에 있어서는 민감도 84.6%, 특이도 86.7% 부분 층 파열에 대해서는 민감도 84.6%, 특이도 73.3%의 고른 결과를 보였지만, 파열의 크기를 예측하는 데는 CTA보다 낮은 정확성을 보였다. 결론: 두 검사 모두 회전근 개 질환에서 우수한 진단적 가치를 보였으며, CTA는 동일 환자에서 시행한 초음파 검사와 비교할 때, 부분 층 파열에 대한 정확성은 떨어지나, 파열의 크기를 예측하는 데는 더 높은 효용성을 보였다.

• 대한관절경학회지
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• 제6권2호
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• pp.126-130
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• 2002

목적 : 견봉하 점액낭에 가려져 부분층 파열로 여겼던 회전근개 전층 파열을 견관절 내 공기 주입 방식을 사용한 견봉하 점액낭 관절경적 관찰로 효과적인 진단의 가능 여부를 알아 보고자 하였다. 대상 및 방법 : 65예 중 견관절 관절경상 회전근 개 부분층 파열인 18예를 제 1군으로, 전층 파열로서 봉합을 시행 한 37예를 제 2군으로 나누어 견관절에 $50\~100ml$의 공기주입으로 확장을 시킴과 동시에 견봉하 관절내로 누출 되는 공기 방울을 관찰하였다. 결과 : 제 1군 중 3예에서 공기 누출을 보고 전층 파열임을 확인할 수 있었으며, 제 2군 중 2예에서는 다량의 공기 누출 부위가 발견되어 불완전한 봉합임을 확인하고 추가 봉합을 시행 할 수 있었다. 결론 : 공기 주입 방식은 회전근 개 부분층 파열과 전층 파열을 감별하고, 비후되고 유착된 점액낭에 가려져 있는 전층 파열을 발견할 수 있으며, 술 후 봉합 부위의 평가에 유용한 방법으로 사료된다.

• 대한정형외과학회지
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• 제55권5호
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• pp.426-430
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• 2020

극상건의 부분 파열(partial thickness tear)이 자기공명영상이나 Middleton, Crass position하의 정적초음파영상에서는 관찰되지 않는 경우가 있다. 저자들은 견관절의 extension position에서 저항 scaption (resisted scaption 또는 scapular plane abduction)을 이용한 동적초음파 검사를 이용하면 다른 영상의학적 도구나 자세에서 진단을 놓칠 수 있는 극상건의 부분 파열도 효과적으로 관찰할 수 있음을 여러 증례를 통하여 경험하였다. 현재까지 극상건 부분 파열을 진단하기 위한 동적 검사 방법은 문헌으로 보고된 적이 없었던 바, 이에 두 증례를 통하여 저항 scaption을 이용한 동적 초음파에 대한 저자들의 술기를 보고하고자 한다.

• Clinics in Shoulder and Elbow
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• 제1권2호
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• pp.266-277
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• 1998

Forty-nine partial thickness rotator cuff tears underwent arthroscopic debridement or repair, and were followed up for a minimum of two years. Follow-up evaluations of the results were completed using a detailed functional questionnaire which was comprised of a rating of the UCLA shoulder scale and return to the previous sports activity and job. The average age of the 49 study patients was 46.5 years(range, 14 to 67 years). The patients were divided into four groups on the basis of the onset of the patient's symptoms. Thirty-five patients(72%) had partial tearing only on the articular surface, six(12%) on the bursal surface, and eight(16%) on both surfaces. Group I consisted of 21 patients with an average age of 56.7. Partial tearing in group I was attributed to the impingement syndrome. In group II, partial tearing of the rotator cuff was related to the anterior instability of the shoulder. This group included 9 patients with an average age of 27.9. In group III, all of the 8 patients were overhead athletes with an average age of 21.8. In this group, no isolated instances of significant trauma were related to the development of the shoulder pain. In group IV, 11 patients noted that a significant traumatic event preceded the onset of their pain. The average age of the patients was 34.9. Overall, 82% of the patients demonstrated satisfactory results and 18% revealed unsatisfactory results. The worst UCLA score and rate of return to the prior activity was noted in group III. In conclusion, partial thickness rotator cuff tear can be caused by subacromial impingement, instability, repetitive microtrauma, and macrotrauma. Arthroscopic debridement of partial tear of the rotator cuff provides a favorable outcome except in overhead athletes.

• Clinics in Shoulder and Elbow
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• 제17권2호
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• pp.91-100
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• 2014

Partial-thickness rotator cuff tear (PTRCT) is not single disease entity but one phase of disease spectrum. Symptoms of PTRCT vary from being asymptomatic to severe pain leading to deterioration in quality of life. Pathogenesis of degenerative PTRCT is multifactorial. Whereas articular sided PTRCT is usually caused by internal causes, both internal and external causes have important role in bursal sided PTRCT. A detailed history, clinical examination and magnetic resonance angiography are used in the diagnosis of PTRCT. Treatment of PTRCT is chosen based on age, demands of patients, causes and depth of tear. In most patients, non-operative treatment should be initiated. Whereas debridement can be done for less than 6 mm of articular sided PTRCT and in less than 3 mm of bursal sided PTRCT, repair techniques should be considered for higher grade PTRCT than that. Although the effect of acromioplasty is not clear, acromioplasty may be performed when the extrinsic causes appear to be the cause of tear. Either transtendon repair technique or repair after tear completion provided satisfactory clinical outcomes in treatment of articular sided PTRCT.

• Clinics in Shoulder and Elbow
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• 제22권3호
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• pp.135-138
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• 2019

Background: The aims of this study were (1) to examine the footprint of the subscapularis tendon using the traditional posterior portal and $30^{\circ}$ arthroscope by simple internal rotation of the arm during surgery, and (2) to classify the pattern of a subscapularis partial-thickness tear. Methods: This study analyzed a total of 231 patients with a partial-thickness subscapularis tear from 550 consecutive patients undergoing an arthroscopic operation who had a visualization of the subscapularis tendon footprint by internal rotation of the arm. First, the patients were classified into four categories according to the tear pattern: (1) stable lamination, (2) unstable lamination, (3) avulsion, and (4) laminated avulsion. Randomized arthroscopic videos were reviewed blindly by two independent orthopedic surgeons. The pattern of the tear of the subscapularis at the neutral position and after internal rotating the arm were assessed and compared with the treatment decision (level IV case series). Results: Stable lamination, unstable lamination, avulsion, and laminated avulsion were observed in 9.1% (n=21), 20.8% (n=48), 41.1% (n=95), and 29.0% (n=67) of cases, respectively. In 145 out of 231 cases (62.8%), the decision was changed after inspecting the footprint after internal rotation of the arm, and the treatment method was changed in 116 (50.2%) cases. Conclusions: In a subscapularis tendon partial-thickness tear, inspecting the footprint of the subscapularis tendon is essential to diagnosing and deciding on the appropriate treatment. In addition, simply internal rotating the arm during surgery when using the traditional posterior portal and $30^{\circ}$ arthroscope can be a valuable method.

• Clinics in Shoulder and Elbow
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• 제22권3호
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• pp.139-145
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• 2019

Background: The present study was undertaken to evaluate the relationship between location of the rotator cuff tear and shape of the subacromial spur. Methods: Totally, 80 consecutive patients who underwent arthroscopic repair for partial thickness rotator cuff tear were enrolled for the study. Bigliani's type of the acromion, type of subacromial spur, and location of partial thickness tear of the rotator cuff were evaluated using plain X-ray and magnetic resonance imaging. We then compared the groups of no spur with spur, and heel with traction spur. Results: Of the 80 cases, 25 cases comprised the no spur group, and 55 cases comprised the spur group. There was a significant difference in type of tear (p=0.0004) between these two groups. Bursal side tears were significantly greater (odds ratio=6.000, p=0.0007) in the spur group. Subjects belonging to the spur group were further divided into heel (38 cases) and traction spur (17 cases). Comparing these two groups revealed significant differences only in the type of tear (p=0.0001). Furthermore, the heel spur had significantly greater bursal side tear (odds ratio=29.521, p=0.0005) as compared to traction spur. Conclusions: The heel spur is more associated to bursal side tear than the traction spur, whereas the traction spur associates greater to the articular side tear.

• Clinics in Shoulder and Elbow
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• 제6권1호
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• pp.72-79
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• 2003

Purpose: To compare the results of arthroscopic rotator cuff repair and subacromial decompression in partial thickness rotator cuff tear (PTRCT) with those in full thickness rotator cuff tear (FTRCT). Subjects and method: Of the 46 patients who were rested of the rotator cuff tear based on the operational findings, 42 patients who were able to receive a serial follow-up for 2 years were selected as the study subjects. The average age of the patients at the time of the operation was 55 years, and the mean duration of the follow-up was 34 months. The subjects included 22 cases of PTRCT and 20 cases of FTRCT. In terms of rotator cuff repair, the average number of tendon to tendon repair (TTR) was 1 in both PTRCT and FTRCT, and that of tendon to bone repair (TBR) was 1 and 3 in PTRCT and FTRCT, respectively. The average number of use of suture anchor was 1 and 2 in PTRCT and FTRCT, respectively. The level of shoulder pain and function of the subjects were measured using shoulder functional evaluation score of American shoulder and elbow society (ASES score) at before and 2 years following the operation. Results: At the final follow-up following the operation, PTRCT group showed changes in scores from 7.2 to 0.9 on average pain score and 34 to 91 on ASES score, whereas FTRCT group showed changes in scores from 7.6 to 1.2 on pain score and 29 to 88 on ASES score. There were no significant differences between the two groups (P > 0.05). The average range of motion of shoulder significantly increased in both groups at the final follow-up in comparison with the pre-operative time point. The evaluation at the final follow-up showed that 93% of the total subjects showed good or excellent results, and 95％ showed satisfactory results from the procedure with regard to pain reduction and functional outcomes. Two cases of the 3 fair results were caused by acromioclavicular arthritis. Conclusion: It may be anticipated that arthroscopic rotator cuff repair and subacromial decompression may bring satisfactory post-operative outcomes in both PTRCT and FTRCT on pain relief and functional recovery. However, careful preoperative examination of the acromioclavicular joint is critical to avoid failures of these procedures.