Rotator cuff tears in proximal humeral fractures: an MRI cohort study in 76 patients.

BACKGROUND: The aim was to evaluate if concomitant injury to the rotator cuff is important for functional outcome in proximal humerus fractures, and to relate loss of function to malunion of the fractures. MATERIALS AND METHODS: A total of 76 patients treated conservatively for proximal humerus fracture were included in this cohort study. Performing an MRI: examination at the time of injury and after 12 months, tears of the rotator cuffs were classified as partial- or full thickness. The fractures were classified, according to the AO classification, and the degree of tubercle displacement and humeral head inclination evaluated at 12 months. Constant score was used as outcome measure. RESULTS: Magnetic resonance imaging (MRI) examinations confirmed 22 rotator cuff tears (four full thicknesses) diagnosed at the time of injury, and 10 additional tears (three full thicknesses) at one year. Functional loss at one year significantly corresponded to the tears at the time of injury (P = 0.004), varus malunion of the head and displacement of tubercles (P < 0.001). INTERPRETATION: Partial- as well as full thickness tears of the rotator cuff are important for functional outcome. Skeletal deterioration seems even more important.

MRI of symptomatic and asymptomatic full-thickness rotator cuff tears. A comparison of findings in 100 subjects.

BACKGROUND AND PURPOSE: Why some full-thickness rotator cuff tears are symptomatic and others are asymptomatic is not understood. By comparing MRI findings in symptomatic and asymptomatic tears, we wanted to identify any tear characteristics that differed between groups. PATIENTS AND METHODS: 50 subjects with asymptomatic and 50 subjects with symptomatic full-thickness tears were examined by MRI. Tear characteristics including tear size, tear location, the condition of the long head of the biceps, atrophy, and fatty degeneration of the muscles were compared between groups. RESULTS: Single factor logistic regression analysis showed that there were statistically significant associations between symptoms and tear size exceeding 3 cm in the medial-lateral plane, positive tangent sign, and fatty degeneration exceeding grade 1 of the supraspinatus and infraspinatus muscles. INTERPRETATION: We found associations between the symptomatic status of a rotator cuff tear and MRI-derived tear characteristics. The causal relationships are unclear.