Natural History of Rotator Cuff Tears
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Abstract:
Rotator cuff tears are a frequent phenomenon with an increasing incidence when the patient gets older. A considerable number of tears remain asymptomatic during a lifetime. However, still, a substantial number of asymptomatic tears become symptomatic. There is, at present evolving evidence that surgical treatment of small to medium-sized tears does better than conservative treatment, even after a long term follow-up. A treatment algorithm is suggested to help the clinician in decision making, where tear size and age are important factors in the prognosis of surgical treatment. Keywords: Rotator cuff; Ruptures; Natural historyf tears; Partial rotator cuff tears; Subscapularis tears; Geometric Classification; Arthroscopic Classification; Rotator cuff retraction; Rotator cuff tendon quality; Prognosis for Rotator Cuff tears.Keywords:
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Rotator cuff tears are a frequent phenomenon with an increasing incidence when the patient gets older. A considerable number of tears remain asymptomatic during a lifetime. However, still, a substantial number of asymptomatic tears become symptomatic. There is, at present evolving evidence that surgical treatment of small to medium-sized tears does better than conservative treatment, even after a long term follow-up. A treatment algorithm is suggested to help the clinician in decision making, where tear size and age are important factors in the prognosis of surgical treatment. Keywords: Rotator cuff; Ruptures; Natural historyf tears; Partial rotator cuff tears; Subscapularis tears; Geometric Classification; Arthroscopic Classification; Rotator cuff retraction; Rotator cuff tendon quality; Prognosis for Rotator Cuff tears.
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We operated on 215 cases with rotator cuff tears from July 1986 to 1993. Subjects consisted of 169 males and 46 females, with 163 right shoulder and 64 left shoulder disorders.Ages ranged from 27 to 81 years with an average of 55.9 years. This paper reports the technique of repair of tears of the rotator cuff. The greatest challenge of repair of rotator cuff injuries is dealing effectively with the torn retracted cuff tendons.Chronic tears are characterized by significant retraction, fibrosis and attenuation of the cuff tendons.
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The size and location of intratendinous and joint side rotator cuff tears can be diagnosed by a technique known as positional arthrography. The site and extent of the tears diagnosed preoperatively by this technique correlated well with intraoperative findings in a study group of 200 patients who underwent a combined arthroscopic and open procedure to localize, identify, and repair incomplete rotator cuff tears.
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Most studies of rotator cuff repairs report high success rates. However, the majority of these studies combine the results of surgical management of rotator cuff tears of various sizes; few published reports specifically evaluate the management of chronic massive tears. Chronic massive rotator cuff tears may be acute traumatic, chronic atraumatic, or acute-on-chronic. A detailed history and thorough physical examination often are sufficient to establish the diagnosis. Radiographic evaluation can reveal osseous changes suggestive of pathology. Magnetic resonance imaging can determine the size of rotator cuff tears and status of the muscles but generally is not necessary for patients who are not candidates for surgery. Chronic massive rotator cuff tears without glenohumeral arthritis can be managed nonsurgically or with subacromial débridement, rotator cuff repair, or rotator cuff reconstruction. However, treatment of these patients is challenging, and results are comparatively inferior to those of treating patients with smaller rotator cuff tears.
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Partial-thickness rotator cuff tears are among the most common challenges faced by orthopaedic surgeons today. The ability to adequately manage these injuries depends on identifying their full extent during arthroscopic evaluation. There are many ways to fully visualize these tears, including arm positioning and gentle debridement. The purpose of this article is to highlight several tips and techniques to enable full visualization of partial-thickness rotator cuff tears to determine appropriate treatment.
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