Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original articleInternal impingement in the etiology of rotator cuff tendinosis revisited
Section snippets
Methods
We retrospectively reviewed the records of 75 shoulders in 72 patients (3 bilateral) with arthroscopically proven partial-thickness articular-sided rotator cuff tears to determine the prevalence of superior labral lesions. These shoulders were part of a series of 79 shoulders previously reported.7 One of the 4 patients not included had an isolated bursal-sided partial-thickness rotator cuff tear (he also had no superior labral lesion). The other 3 were excluded because of incomplete records.
Results
Fifty-one shoulders (68.0%) had the articular-sided partial-thickness rotator cuff tears isolated to the supraspinatus, 21 shoulders (28%) had partial-thickness tears involving the supraspinatus and infraspinatus, 2 shoulders had tendinosis isolated to the infraspinatus, and 1 shoulder had tendinosis of the supraspinatus and subscapularis. Overall, 73 of 75 (97.3%) shoulders had involvement of the supraspinatus.
Fifty-five of 75 (73.3%) shoulders with articular-sided tears had type I labral
Discussion
In this study, 55 of 75 (73.3%) patients from a general, recreational athletic population were found to have superior labral fraying associated with undersurface partial-thickness rotator cuff tears. Others have previously commented on the high prevalence of superior labral fraying in combination with articular-sided rotator cuff pathology. Altchek et al.9 noted a 40% incidence of this combination. Guidi et al.10 noted superior labral degeneration in 90% of patients with partial-thickness
Conclusions
This study documents a high prevalence of superior labral fraying in a general, recreational athletic population with undersurface partial-thickness rotator cuff tears. These lesions occur very frequently in patients who do not routinely engage in overhead athletics and, therefore, may be caused by mechanisms other than internal impingement. They may be better explained by tension overload of the rotator cuff and repetitive superior shearing of the humeral head against the labrum. The proven
Acknowledgements
The authors thank Micheal A. Conditt, Ph.D., for help with the statistical analysis.
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