Massive rotator cuff tear pattern and loss of active ROM
To date, there is no generally accepted consensus on the definition of a massive rotator cuff tear, and often when massive rotator cuff tears are classified to the same group based on size, clinical symptoms differ greatly. Rotator cuff tear pattern may be an important factor influencing symptoms and prognosis.
The current study compared active shoulder ROM in 100 patients with rotator cuff tears in two or more tendons and Goutallier grade 3 or more fatty infiltration. Tear patterns were defined as follows: A) supraspinatus and superior subscapularis; B) supraspinatus and full subscapularis; C) infraspinatus, supraspinatus, superior subscapularis; D) supraspinatus and infraspinatus; E) supraspinatus, infraspinatus, teres minor.
All patients with type A tears were able to perform elevation above shoulder level and 80% of the patients with type B tears had pseudoparalysis, while the only difference between these two conditions was tear pattern of the subscapularis: this muscle seems to be essential for maintaining elevation. Moreover, pseudoparalysis was only observed in tear patterns B, C and E, indicating involvement of three or more muscles as a risk factor for pseudoparalysis.
> From: Collin et al., J Shoulder Elbow Surg 23 (2015) 1195-1202. All rights reserved to the Journal of Shoulder and Elbow Surgery Board of Trustees. Click here for the Pubmed summary.