Partial rotator cuff injury in athletes: bursal or articular?

Comparative Clinical Evaluation of Two Techniques of Arthroscopic Treatment of Partial Articular Rotator Cuff Tears

Objectives  To evaluate the clinical results of patients submitted to arthroscopic treatment of partial lesion of the articular part of the rotator cuff by transtendon suture techniques and after completing the lesion and to compare the postoperative recovery time of the two techniques. Method  Retrospective study based on the identification of all cases with partial lesion of the articular part of the rotator cuff submitted to arthroscopic treatment from October 1999 to December 2016 at the Shoulder and Elbow Group of our institution. Thirty-nine patients were included and divided into two groups: those who underwent the transtendon technique and those in whom the lesion was completed. The two groups were statistically similar. The respective medical records were analyzed as well as the identification of the applied technique, the postoperative results, and the related complications. The functional evaluation was performed using the score of the University of California at Los Angeles (UCLA). Results  There was no statistically relevant difference between the groups, with a mean UCLA score of 32, and no difference in the time required for rehabilitation. Conclusion  There was no difference between the clinical outcome of the patients, regardless of the technique used to repair the partial lesions of the articular part of the rotator cuff, with satisfactory results in 93% of the cases.

Magnetic resonance imaging of the shoulder

The aim of this article is to review the use of magnetic resonance imaging (MRI) for the evaluation of shoulder pain, which is a common clinical complaint of the musculoskeletal system. MRI is an essential auxiliary tool to evaluate these patients because of its high resolution and high sensitivity in depicting the soft tissues. This article will review the imaging technique, normal imaging anatomy, and most common imaging findings of disorders of tendons, labrum, and ligaments of the shoulder. It will also discuss common systemic diseases that manifest in the shoulder as well as disorders of the acromioclavicular joint and bursae. New advances and research in MRI have provided additional potential uses for evaluating shoulder derangements.

In situ repair of partial-thickness rotator cuff tears: a critical analysis review

After failed conservative management, operative intervention is typically indicated for patients with partial-thickness rotator cuff tears (PTRCTs) with persistent pain and disability symptoms.

For PTRCTs involving < 50% of the tendon thickness, debridement with or without acromioplasty resulted in favourable outcomes in most studies.

For PTRCTs involving > 50% of the tendon thickness, in situ repair has proven to significantly improve pain and functional outcomes for articular and bursal PTRCTs.

The few available comparative studies in the literature showed similar functional and structural outcomes between in situ repair and repair after conversion to full-thickness tear for PTRCTs.

Most non-overhead athletes return to sports at the same level as previous to the injury after in situ repair of PTRCTs. However, rates of return to preinjury level of competition for overhead athletes have been generally poor regardless of the utilized technique.

During long-term follow-up, arthroscopic in situ repair of articular and bursal PTRCTs produced excellent functional outcomes in most patients, with a low rate of revision.

Cite this article: EFORT Open Rev 2020;5:138-144. DOI: 10.1302/2058-5241.5.190010

Management of Rotator Cuff Injuries in the Elite Athlete

PURPOSE OF REVIEW

Rotator cuff injuries are a common cause of pain and dysfunction for the elite athlete and can result in time loss from participation. This review highlights the current management of these injuries.

RECENT FINDINGS

Conservative management of rotator cuff injuries continues to be the "gold standard" in the elite athlete. This includes a comprehensive rehabilitation program, anti-inflammatories, and corticosteroid injections. Newer treatment techniques such as intramuscular dry needling and the use of biologics such as platelet-rich plasma and stem cells demonstrate early promising results; however, these modalities require further investigation to determine their effectiveness. Rotator cuff injuries can range from contusions and tendinopathy to full-thickness tears. A comprehensive evaluation is needed to determine the extent of injury and appropriate plan of care. Management strategies can range from rehabilitation to operative intervention and are guided by the size of the tear, time of season, sport, performance limitations, and presence of concomitant pathology.