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Plenary speaker presents state of research, clinical work into partial rotator cuff tears
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PRAGUE — Orthopedists must pay closer attention to partial rotator cuff tears, according to a plenary lecture delivered here.
In his presentation at the SICOT XXV Triennial World Congress 2011, Christian Gerber, MD, FRCSed, Chairman of the Department of Orthopaedic Surgery at Balgrist University Hospital in Zurich and three-time winner of the Neer award, said, “Small tears may be completely irrelevant,” but they must be managed well.
When first diagnosed, he noted, partial rotator cuff tears do little harm, but can be problems waiting to happen. Gerber showed several examples and cited relevant studies during his half-hour presentation to convey some key take home messages.
Among them: Warding off further deterioration of the rotator cuff in these situations demands skill in both arthroscopy and imaging.
Another point Gerber made was that orthopaedists need to understand the rotator cuff anatomy thoroughly.
“The rotator cuff is an anatomical structure,” he said. “The structure is the subscapularis, the supraspinatus, the infraspinatus … and the teres minor. However, you really need to understand how the rotator cuff functions.”
Particularly telling were findings that Gerber presented indicating that fatty infiltration sets in soon after even a very small insult to the rotator cuff.
“If we look at partial tears — partial tendon tears — which are completely normal and are Goutallier grade 0 or 1, there is no fat in there. They are the same on MRI or on CT arthrography, but we already have lipids which are below the threshold of MR imaging,” Gerber said.
He reviewed in detail some special problems associated with partial rotator cuff tears, including the following:
- Bursal side tears from subacromial impingement;
- Infra-tendinous tears not detectable arthroscopically, which require MRI to diagnose;
- Laminated tears, where tendon layers are stressed differently by the anatomy, and
- Articular side tears seen readily on arthroscopy.
Reference:
- Gerber C. Plenary lecture: Partial rotator cuff tears. Presented at the SICOT XXV Triennial World Congress 2011. Sept. 6-9. Prague.
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