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Scientific Articles   |    
Location and Initiation of Degenerative Rotator Cuff TearsAn Analysis of Three Hundred and Sixty Shoulders
H. Mike Kim, MD1; Nirvikar Dahiya, MD2; Sharlene A. Teefey, MD2; William D. Middleton, MD2; Georgia Stobbs, RN1; Karen Steger-May, MA3; Ken Yamaguchi, MD1; Jay D. Keener, MD1
1 Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University School of Medicine, 1 Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address for J.D. Keener: keenerj@wudosis.wustl.edu
2 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO 63110
3 Division of Biostatistics, Washington University School of Medicine, 660 South Euclid Avenue, Box 8067, St. Louis, MO 63110-1093
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Institutes of Health (R01Grant AR051026-01A1). One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Tornier).

A commentary by Brian N. Victoroff, MD, is available at www.jbjs.org/commentary and as supplemental material to the online version of this article.
Investigation performed at the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 May 01;92(5):1088-1096. doi: 10.2106/JBJS.I.00686
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Abstract

Background: 

It has been theorized that degenerative rotator cuff tears most commonly involve the supraspinatus tendon, initiating at the anterior portion of the supraspinatus insertion and propagating posteriorly. The purposes of this study were to determine the most common location of degenerative rotator cuff tears and to examine tear location patterns associated with various tear sizes.

Methods: 

Ultrasonograms of 360 shoulders with either a full-thickness rotator cuff tear (272) or a partial-thickness rotator cuff tear (eighty-eight) were obtained to measure the width and length of the tear and the distance from the biceps tendon to the anterior margin of the tear. Tears were grouped on the basis of their size (anteroposterior width) and extent (partial or full-thickness). Each tear was represented numerically as a column of consecutive numbers representing the tear width and distance posterior to the biceps tendon. All tears were pooled to graphically represent the width and location of the tears within groups. Frequency histograms of the pooled data were generated, and the mode was determined for each histogram representing various tear groups.

Results: 

The mean age (and standard deviation) of the 233 subjects (360 shoulders) was 64.7 ± 10.2 years. The mean width and length of the tears were 16.3 ± 12.1 mm and 17.0 ± 13.0 mm, respectively. The mean distance from the biceps tendon to the anterior tear margin was 7.8 ± 5.7 mm (range, 0 to 26 mm). Histograms of the various tear groups invariably showed the location of 15 to 16 mm posterior to the biceps tendon to be the most commonly torn location within the posterior cuff tendons. The histograms of small tears (a width of <10 mm) and partial-thickness tears showed similar distributions of tear locations, indicating that the region approximately 15 mm posterior to the biceps tendon may be where rotator cuff tears most commonly initiate.

Conclusions: 

Degenerative rotator cuff tears most commonly involve a posterior location, near the junction of the supraspinatus and infraspinatus. The patterns of tear location across multiple tear sizes suggest that degenerative cuff tears may initiate in a region 13 to 17 mm posterior to the biceps tendon.

Clinical Relevance: 

The findings of this study speak to the specific location of the most common type of rotator cuff lesions, degenerative rotator cuff tears.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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