A Small (Degenerative) Supraspinatus Tear Needs No Repair
Authors: Rolf Norlin
References: Presented at ICSES 2010
From both a mechanical and biological view not all holes in the rotator cuff needs to be repaired. Degenerative not acute - tears within the supraspinatus tendon may well be treated without repair. If the preoperative subacromial injection test is positive and results in a near normal active range of motion with good abduction strength then usually a subacromial decompression will provide excellent clinical results without the risk of later progression of the hole (tear). Several studies show that asymptomatic holes (tears?) are present in a surprisingly high percentage. This percentage increases with increasing age. Also more recent studies support this fact (Sher et al 1995, Reilly et al 2006). This knowledge may lead to the conclusion that even if a hole (tear) is found this tear is not the cause for the pain and the impaired function. A subacromial decompression may well lead to a satisfactory result relieving the patient from pain, as well as weakness. Poulliart have shown that there is a stable ligament-like structure on the undersurface of the supraspinatus tendon. She calls this the transverse band. In previous descriptions this structure has been termed cable construct. If the tear of the tendon is within the cable construct than the tear is stable and the biomechanics of the supraspinatus is maintained. The tear presents itself as a crescent-like full-thickness tear within the supraspinatus tendon. Our long term follow-up (Norlin & Adolfsson JSES 2008) shows clearly that decompression only will result in durable pain relief and good shoulder function more than a decade after the surgery. No progression of tear size was found.