Rotator cuff
A spectrum of abnormal changes can be found in the rotator cuff. The first evidence of impingement may be reddening of the cuff, and an increase in small-size vessels in the synovium (Figure 6.5). The next stage in the sequence is a 'hairy' degeneration of the cuff in the impingement area (close to the biceps tunnel) (Figure 6.6). The next stage is seen as a deep surface tear (Figure 6.7).
Figure 6.5 Vasculitis of the rotator cuff.
Figure 6.6 Fraying of the rotator cuff at the impingement point, c = cuff, b = biceps, h = humeral head.
Figure 6.7 Partial thickness rotator cuff tear covered with thickened synovium.
Figure 6.8 Full thickness rotator cuff tear.
Finally, the partial thickness tear will give way to a full thickness tear (Figure 6.8), which matures to give rounded-off edges (Figure 6.9) through which can be seen bursal proliferation and the undersurface of the acromion (Figure 6.10).
Figure 6.9 A full thickness rotator cuff tear has rounded mature edges and the proliferative bursal tissue hangs down through it.
Figure 6.10 A collage of arthroscopic photographs to show the rotator cuff tear seen in Figure 6.9 in relation to the rest of the joint.
Massive rotator cuff tears may be confusing initially. Instead of the rotator cuff the undersurface of the acromion is seen, and when probed it can be appreciated just how massive a cavity is present (Figures 6.11 and 6.12).
Figures 6.11 and 6.12 In a massive rotator cuff tear, the edges may not be seen. There is just a large and very irregular cavity, the size of which can be judged by the extent to which the hook probe travels.
