Bursal-sided rotator cuff tear
Bursal-sided rotator cuff tears are referred to as partial-thickness rotator cuff tears extending from the bursal side into the rotator cuff.
Epidemiology
Bursal-sided rotator cuff tears are less common than articular-sided rotator cuff tears or intra-substance tears in cadaver studies an increase with age .
Associations
- subacromial impingement
- spurs on the acromion undersurface
Pathology
Etiology
Bursal-sided rotator cuff tears are associated with subacromial impingement. Intrinsic factors include the relative hypovascularity of the distal parts of tendon and the footprint and age-related microscopic changes are probably further intrinsic factors .
Variants
- a bursal-sided rim rent tear of the footprint, most commonly found at the tendon insertion of the supraspinatus tendon is called reverse-PASTA lesion
- a bursal-sided partial-thickness tear with intratendinous extension should be described as such since delamination hamper healing potential of the tendon
Radiographic features
Ultrasound
- focal hypoechoic or anechoic defect of the rotator cuff, extending from the bursal side into the tendon substance
MRI
- focal non-transmural bursal-sided defect of fluid signal intensity of the rotator cuff on fat-saturated T2- weighted or intermediate-weighted images with intact residual fibers
MR/CT arthrography
Unless the contrast medium is injected into the subacromial-subdeltoid bursa, which will fill the tear with contrast , MR and CT arthrography is not of much additional use to MRI in isolated bursal-sided rotator cuff tear .
Treatment and prognosis
Partial-bursal sided tears can be initially treated conservatively. Surgery is indicated for patients, who failed conservative treatment and younger patients with a single acute injury and include debridement and repair the latter, especially in larger tears . Subacromial decompression might be an option if there are extrinsic risk factors for subacromial impingement .
See also
