Review Question - QID 3698

The history, examination, and imaging are consistent with a partial articular-sided supraspinatus tendon avulsion (PASTA). Physical therapy including shoulder range of motion and rotator cuff/periscapular stabilizer strengthening is the most appropriate initial treatment for the options provided.

Partial-thickness rotator cuff tears are most commonly classified by location (articular- or bursal-sided) and size (greater or less than 50% thickness). If conservative treatment options fail, then partial-thickness, articular-sided rotator cuff tears >50% can be treated with completion and repair (open or arthroscopic). If the tear is <50% then treatment consists of débridement of the tuberosity and undersurface rotator cuff. Repair of the tendon in situ (ie, partial articular supraspinatus tendon avulsion [PASTA] repair) is possible when remaining attached tissue is healthy. There are several studies that describe the anatomy of the supraspinatus footprint with an average maximum insertional length and width of 23 x 16 mm. The ABER position for MRI reduces the effacement of its articular surface on the humeral head. This reduced tension allows intra-articular contrast to flow into the defect and increases the sensitivity of detecting partial-thickness tears.

Sher et al performed MR examinations of 94 subjects with asymptomatic shoulders. When including both partial and full-thickness tears, they found the overall prevalence in all age-groups was 34%, and that this increased with patient age. Over 50% of the patients older than 60 years old and 28% of patients 40-60 years old had evidence of a rotator cuff tear. Only 4% of the patients aged 19-39 had a rotator cuff tear.

Illustration A depicts a PASTA lesion of the supraspinatus of a left shoulder as viewed from a posterior portal in the lateral decubitus position. Video A demonstrates a partial articular-sided supraspinatus tendon avulsion (PASTA) undergoing side-to-side repair.