肩関節との交通がない腱板部分断裂の臨床像の検討

概要

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We reviewed clinical features of partial thickness rotator cuff tears which could not be diagnosed by shoulder arthrogram, but were diagnosed by bursogram (BG) or MRI. There were eleven shoulders with an average age of 56 years old (41-71 years old). 7 shoulders had a severe trauma at the onset. The average time from the onset to BG or MRI was 6 months, and to operation was 7 months. 4 shoulders showed pooling of contrast media in the supraspinatus tendon with BG. 10 shoulders MRI examination showed the stump of tear which was distal from the center of the facet in 3 shoulders, and proximal in 7. In the intraoperative observation, there were 10 bursal surface tears (BSTs) and an intratendinous tear (ITT). All BSTs were supraspinatus tendon avulsion from its bursal side insertion with depth exceeding 1/2 of the thickness of the tendon. The longitudinal diameter of the BST was less than 15mm in five shoulders, and more than 20mm in five shoulders. Statistical analysis revealed no relationship between longitudinal diameter of the BSTs and the period from the onset to the operation. It was thought that the BST arise as large size tear with intact capsule of deep layer from the onset. BG was useful for a diagnosis of BST with depth exceeding 1/2 of the thickness of the tendon. MRI was similarly useful for a diagnosis of the partial thickness tear, but the ITT was not distinguished from the BST.