Can Supraspinatus Tears Contribute to Acquired Subcoracoid Impingement? A Radiological Study of Anterosuperior Cuff Tears

Abstract

Backgroud. Many subscapularis (SubS) lesions represent the result of the progression of anterosuperior cuff tears, although their pathophysiology is still relatively unknown. The goal of this paper was to determine the influence of supraspinatus tears in the development of subcoracoid impingement and therefore SubS tears. Methods. This is a retrospective, controlled and single-blinded study. We analyzed 301 patients with rotator cuff pathology and an MRI study. The coraco-humeral distance and coracoid overlap were measured. The presence of supraspinatus and subscapularis lesions were also evaluated. Results. Supraspinatus tears were found to be associated with the presence of subscapularis tears (p = 0.003). A significant relationship (p = 0.002) was achieved between supraspinatus tears and inferior coraco-humeral distance, with average values of 8.4 ± 2.9 mm and 10.2 ± 3.2 mm in shoulders with and without supraspinatus tears respectively. On the opposite side, there wasn't a significant association between supraspinatus tears and the coracoid overlap. Conclusions. This paper is, to our knowledge, the first to study the influence of supraspinatus tears in different parameters implied in subscapularis tears pathology, representing also the largest published sample on this theme, including 301 patients. Finally, this study offers an explanation for anterosuperior cuff progression pathophysiology, confirming that supraspinatus full thickness tears can lead to a secondary subcoracoid impingement and thus subscapularis tears.