• Clinics in Shoulder and Elbow
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• v.27 no.1
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• pp.79-87
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• 2024

Rotator cuff disease is a common cause of shoulder pain for which partial-thickness rotator cuff tears occupy a significant proportion. Such tears are often difficult to diagnose and manage in the general clinic setting. A review of the available literature from well-known databases was performed in this study to provide a concise overview of partial-thickness rotator cuff tears to aid physicians in their understanding and management.

• Clinics in Shoulder and Elbow
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• v.22 no.1
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• pp.50-57
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• 2019

Rotator cuff tear is a common cause of shoulder pain and disability in adults. Due to the various nature of progression of rotator cuff tears and the complex biomechanics of the shoulder joint, repair and treatment of large-to-massive tears are challenging for many surgeons. Despite the recent popularity of reverse total shoulder arthroplasty as a treatment option for large-to-massive irreparable rotator cuff tears, biological and mechanical repair augmentation has also shown promise as a viable treatment option. The purpose of this study was to briefly summarize and review current studies on the assessment and arthroscopic treatment of large-to-massive rotator cuff tears, whether repairable or irreparable, to aid in developing a consensus on future treatment directions.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2009.03a
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• pp.210-210
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• 2009

For a bursal-side retracted laminated rotator cuff tear, simple repair of the retracted bursal-side rotator cuff might be insufficient because the repaired tendon could remain as an intratendinous tear of the rotator cuff. We present a repair method for intratendinous rotator cuff tears using the suture-bridge technique. We believe that this method helps to preserve the remnant rotator cuff tendon without tissue damage and restores the normal rotator cuff footprint in bursal-side delaminated rotator cuff tears.

• Clinics in Shoulder and Elbow
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• v.17 no.4
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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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• v.25 no.4
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• pp.328-333
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• 2022

Irreparable rotator cuffs with retracted torn ends remain a significant challenge for most shoulder surgeons. Since repairs are preferable to reconstruction or replacement whenever possible, studies for anatomical reductions with minimal tension and secure fixation are important. In this study, the authors introduce an arthroscopic supraspinatus advancement (ASSA) procedure for retracted rotator cuff tears that could not be adequately reduced to the original footprint. Using modified long, narrow, curved Cobb elevators, procedures can be performed through lateral portals without any additional skin incision. Following meticulous stepwise three-compartment elevation procedures based on the supraspinatus insertion anatomy, the supraspinatus muscle could be safely elevated from the fossa and sufficiently advanced laterally. The authors suggest that ASSA could be a useful procedure for management of challenging retracted rotator cuff tears by maximizing lateral excursions that could convert irreparable tears to reparable tears in select patients.

• Clinics in Shoulder and Elbow
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• v.20 no.2
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• pp.105-112
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• 2017

Rotator cuff tears commonly affect the shoulder joints. Despite developments in surgical techniques and instrumentation, the treatment of massive rotator cuff tears remains challenging. The problems associated with rotator cuff repairs, such as inferior mechanical properties and high retear rates are yet to be solved. Recently, patch augmentation has been suggested as an alternative treatment because it can reinforce mechanical properties at the initial stage of healing and reduce gap formation. The purpose of this article was to comprehensively summarize the concepts and the consensus surrounding patch augmentation and evaluate the clinical and anatomical outcomes after patch augmentation for massive rotator cuff tears.

• Clinics in Shoulder and Elbow
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• v.18 no.4
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• pp.211-216
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• 2015

Background: Few studies have investigated magnetic resonance (MR) characteristics of traumatic posterosuperior rotator cuff tears involving the supraspinatus and infraspinatus. We hypothesized that traumatic rotator cuff tears may have MR characteristics distinguishable from those of non-traumatic tears. Methods: Preoperative MR arthrography and intraoperative tear size measurements were compared in 302 patients who underwent MR arthrography and subsequent arthroscopic rotator cuff repairs for traumatic (group T, 61 patients) or non-traumatic (group NT, 241 patients) tears. The inclusion criteria for both groups were posterosuperior full-thickness rotator cuff tear and age between 40 and 60 years. For group T, traumas were limited to accidental falls or slips, or sports injuries, motor vehicle accidents; injuries were associated with acute onset of pain followed by functional shoulder impairment; and time between injury and magnetic resonance imaging (MRI) was 6 weeks or less. Results: In group T, 72.1% of shoulders (44 patients) had tendon tears with blunt edges while 27.9% of shoulders (17 patients) had tears with tapering edges. In contrast, 21.2% of patients in group NT (51 patients) had blunt-edge tears, while 78.8% (190 patients) of tears had tapering edges. These results were statistically significant (p<0.001) and estimated odds ratio was 9.6. The size of tear did not vary significantly between groups. Conclusions: We found no exclusive MR characteristic to define traumatic tears. However, oblique coronal MRI of traumatic tears showed a significant tendency for abrupt and rough torn tendon edges and relatively consistent tendon thicknesses (without lateral tapering) compared to non-traumatic cuff tears.

• Clinics in Shoulder and Elbow
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• v.22 no.3
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• pp.128-134
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• 2019

Background: Patients with rotator cuff tears are usually afflicted with shoulder pain and disability. However, it is unclear which factors are related to shoulder pain in patients with rotator cuff tears. This study was therefore undertaken to determine the factors correlated with shoulder pain in patients with painful rotator cuff tears, but without any history of trauma. Methods: We evaluated a cohort of 745 patients with painful rotator cuff tears having no trauma history, and analyzed the relationship between pain and multiple factors including demographic data, tear characteristics, and passive range of motion. Pain was analyzed with a questionnaire concerning the visual analogue scale (VAS) for pain. Tear characteristics were determined by evaluating tear size, muscle atrophy, number of torn tendons, and presence of arthritis. Multivariate linear regression analysis and chi-squared test were applied to evaluate the relationship between the VAS for pain and variable factors. Results: Shoulder pain was associated with young age (p=0.01), male sex (p=0.01) and the presence of diabetes mellitus (p<0.001). Measurements of rotator cuff tear characteristics including tear size (p=0.53), muscle atrophy (p=0.16) and the number of torn tendons (p=0.34) did not correlate with shoulder pain. Symptom duration (p=0.60) and range of motion (p>0.05) also showed no correlation with VAS for pain. Conclusions: Young age, male sex and the presence of diabetes mellitus correlated positively with preoperative shoulder pain in patients with painful rotator cuff tears without a trauma history. Combined treatment of pain management and risk factor correction could be helpful to control preoperative shoulder pain.

• Journal of Korean Orthopaedic Sports Medicine
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• v.3 no.2
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• pp.93-97
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• 2004

Continued research needs to be devoted to understanding the natural history of rotator cuff tears. Recent studies have shown progression of tear, symptomatic flare-ups and irreversible change in rotator cuffs managed nonsurgically. These data allow the grouping of patients with rotator cuff tears into three categories based on risk-benefit ratios. Nonsurgical care should be maximized for patients with impingement symptoms only, with partial-thickness tears, with chronic tears, and for the elderly patients. The proper selection of candidates for nonsurgical management should lead to the high success rate quoted by multiple authors. Even though conservative treatment is necessary, early surgery should be considered for tears that are acute, small or medium, associated with shoulder loss of function, or occur in a younger patient. Prolonged nonsurgical care in these patients risks tear propagation and irreversible changes to the cuff, which may complicate rotator cuff repair.

• The Korean Journal of Pain
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• v.24 no.2
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• pp.69-73
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• 2011

Although the incidence of partial-thickness rotator cuff tears (PTRCTs) was reported to be from 13% to 32% in cadaveric studies, the actual incidence is not yet known. The causes of PTRCTs can be explained by either extrinsic or intrinsic theories. Studies suggest that intrinsic degeneration within the rotator cuff is the principal factor in the pathogenesis of rotator cuff tears. Extrinsic causes include subacromial impingement, acute traumatic events, and repetitive microtrauma. However, acromially initiated rotator cuff pathology does not occur and extrinsic impingement does not cause pathology on the articular side of the tendon. An arthroscopic classification system has been developed based on the location and depth of the tear. These include the articular, bursal, and intratendinous areas. Both ultrasound and magnetic resonance image are reported with a high accuracy of 87%. Conservative treatment, such as subacromial or intra-articular injections and suprascapular nerve block with or without block of the articular branches of the circumflex nerve, should be considered prior to operative treatment for PTRCTs.