Der makroskopische Aspekt der Rotatorenmanschettenruptur bei traumatischen und atraumatischen Rupturformen

Abstract

The decision whether a rotator cuff tear has a traumatic or degenerative origin still causes some controversy. Especially in medical expert appraisals the etiology of the rotator cuff tear plays an important role referring to insurance services for the patient. The purpose of this paper is to compare the intraoperative pathomorphologic shape of the cuff tear in traumatic and degenerative cases. This study reports of 56 patients with rotator cuff tears which were divided in primarily acute, subacute traumatic and degenerative study groups referring to their history of present illness. We considered the location of the tear, the shape and the size. Furthermore the grade of retraction of the supraspinatus tendon, its quality and the shape of the long head of biceps were examined. The results showed that in general the shape of the tear gives only in some cases significant information whether the etiology is traumatic or not. The isolated rupture of the subscapularis muscle and the hematoma at the edge of the tendon is significant for the trauma. In comparison with the degenerative study group the tenosynovitis and the dislocation of the long head of biceps is in our study significant for traumatic tears.

Definition of the terms “acute” and “traumatic” in rotator cuff injuries: a systematic review and call for standardization in nomenclature

“…As shown in Fig. 1, a total of 46 studies could be included with 28 studies defining only the term "traumatic" [3,5, and 18 studies defining both terms, "acute" and "traumatic" [39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56]. No study exclusively defining the term "acute" could be detected.…”

“…Of the studies included in this review, histological examinations were only performed in a single study [42]. In this study, two samples of the tendons of each patient were taken and sent to different laboratories for evaluation to distinguish between acute or chronic RCTs based on the absence or presence of hemosiderin.…”

“…In this study, two samples of the tendons of each patient were taken and sent to different laboratories for evaluation to distinguish between acute or chronic RCTs based on the absence or presence of hemosiderin. Due to the heterogeneous and contradictory results in this study, the authors later decided to exclude histopathological examinations in their study [42].…”

“…According to the 18 articles defining the term "acute" with regard to RCTs, the time range was defined between less than 2 weeks up to 6 months (Table 1) [39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56]. These studies can be further subdivided into ten studies, using a period of a minimum of two up to a maximum of 6 weeks as time span for an acute RCT [41,43,[45][46][47][48][49][51][52][53]…”

Stand in der Versorgung der Rotatorenmanschettenruptur

“…ration durch ein akutes Trauma zu einer Vergröûerung des bestehendes Defektes, sodass das klinische Bild einer Rotatorenmanschettenruptur besteht. Isolierte Rupturen der Subscapularissehne entstehen zu 70 % durch ein Trauma [7,51]. In Abhän-gigkeit vom Alter führt eine Schulterluxation in 14±63 % der Fälle zu einer Rotatorenmanschettenruptur [31,39].…”