Nuno Bessa Pinto Leite MD, Presenter: Nothing to Disclose

Anthony John Peduto MD, Abstract Co-Author: Nothing to Disclose

Marcelo A. Nogueira MD, Abstract Co-Author: Nothing to Disclose

Debra Trudell, Abstract Co-Author: Nothing to Disclose

Donald L. Resnick MD, Abstract Co-Author: Nothing to Disclose

Rotator cuff tears are common among elderly persons. Recently, longitudinal fissures, or delamination, as a component of partial thickness tears have been emphasized. Such delamination may lead to full thickness tears and be missed at arthroscopy. This study using MR imaging - anatomic correlation in cadavers was performed to determine if delamination of the supraspinatus tendon is common in elderly persons and, if so, what is its pathogenesis.

Ten fresh frozen cadaveric shoulders derived from persons with a mean age of 80 years (range, 63-90) were studied on a 1.5T MR system. Coronal T1-weighted and fat supressed PD sequences were acquired before and after intrarticular injection of gadolinium. Specimens were then sectioned in the coronal plane. Correlation between MR images and anatomical specimens was performed by consensus of two musculoskeletal radiologists. Histological findings were correlated with those from MR imaging.

All shoulders demonstrated articular surface defects of the supraspinatus tendon, ranging from small cleft like areas to larger articular sided partial thickness tears. Four (40%) of the shoulders that had partial tears showed an associated delaminating component, on MR imaging, anatomic studies, and histological analysis. Grossly, delamination was identified as a linear defect extending between normal tendon fibers. A small area of redness adjacent to the linear defect was noted. Delamination involved predominantly the distal tendon, near its humeral attachment. Histology revealed linear mucoid degeneration between collagen bundles with subsequent cavitation.

Delamination is a common finding in partial thickness tears of the supraspinatus in elderly population. Findings support the theory that delamination results from tensile forces applied in the region of the rotator cuff, where fibers are undergoing rapid change in direction. The presence of a synovial lining in the delaminated surfaces may prevent adherence of adjacent layers and, therefore, healing of the tendon.

Delamination of the supraspinatus tendon is common in an elderly population, and its recognition can change the surgical approach and thus the prognosis of the patients.

Leite, N, Peduto, A, Nogueira, M, Trudell, D, Resnick, D, Delamination of the Supraspinatus Tendon in the Elderly: Common Finding with a Unique Pathogenesis—Cadaveric Study with MR Arthrography, Gross Inspection, and Histology.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4438533.html