Treatment of Partial Thickness Rotator Cuff Tears in Overhead Athletes

Abstract

Purpose of Review To review the etiology, classification, presentation, evaluation, treatment strategy, and outcomes in overhead athletes with partial thickness rotator cuff tears. Recent Findings Despite advances in surgical repair techniques, return to play following surgical repair of partial rotator cuff tears remains modest at best. Summary Overhead athletes may be particularly prone to rotator cuff pathology due to the supraphysiological strains within the tendon during the throwing motion, as well as mechanical stress with contact between the undersurface of the rotator cuff and the glenoid. The true prevalence of partial tears may be underestimated given the high incidence of asymptomatic tears. Both dynamic ultrasound and enhanced contrast MRI have improved our understanding of this pathology. For most overhead athletes, nonoperative management is the most common course. Despite advances in imaging, diagnosis, and surgical techniques, our ability to return these patients to their elite level is modest at best when nonoperative management fails and surgical treatment is performed. If a surgical route is needed, debridement alone is the most frequent procedure given concerns of over constraint and poor return to play with surgical repair of the partial thickness rotator cuff tear.

Surgical Treatment Options for Partial Rotator Cuff Tears: A Review of the Literature

“…In our personal experience, transtendon repairs are more likely to suffer from more and prolonged postoperative pain as well as a higher risk of postoperative stiffness. This is supported by a prospective comparative study by Shin [25] , who compared a transtendon in-situ Figure 4 (out of Garavaglia et al) [43] . Illustration of the modified Lafosse classification for subscapularis tendon tears.…”

“…If conservative treatment fails, debridement alone seems to be superior compared to repair of PRCTs in the throwing athlete [41,43] .…”

Avaliação funcional e comparativa entre pacientes com lesões parciais e completas do manguito rotador

“…Porém, quando há falha desse recurso, apresentando recorrência dos sintomas ou agravamento da lesão, opta-se pelo tratamento definitivo ou cirúrgico. (Liu et al, 2018;Matthewson et al, 2015). Em contrapartida, a lesão completa possui o tratamento preferencialmente cirúrgico quando os pacientes são sintomáticos, não respondem bem ao tratamento conservador, menores de 60 anos e lesões traumáticas.…”

The effectiveness of combined CT arthrography and sub-acromial bursography as a novel modified technique in characterization of rotator cuff tears

“…The distinction between different grades of thickness affection in partial thickness tear is allowed only when concurrent bursography is performed with CTA. To the best of the authors' knowledge, all known studies that assessed the value of CTA in RCTs assessed its value in detection of RCTs, not in their characterization, they were not able to assess the percentage of tendon thickness affection, and this is the first article trying to study and highlight such a point, that would refine the CT arthrographic study when performed in the context of rotator cuff tear [2,4,[10][11][12][13][14]. The sensitivity of CTA and concurrent sub-acromial bursography in detection of rotator cuff tears in arthroscopically treated patients was 100%, whereas the specificity was variable due to false positive results regarding the subscapularis and infraspinatus tendons, it was 100% for supraspinatus tendon tear, 83% for subscapularis tendon tears and 40% for infraspinatus tendon tear.…”