The diagnosis of a partial thickness rotator cuff tear can be challenging. This review describes the reappearing bubble sign that can be a useful adjunct in the evaluation of a partial articular surface tear with an intratendinous extension (PAINT lesion). In addition, we review the clinical examination, radiological imaging and intra-operative techniques that may help in the detection of a partial thickness cuff tear.
ReillyP, MacleodI, MacfarlaneR, WindleyJ, EmeryRJ. Dead men and radiologists don't lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence.Ann R Coll Surg Engl2006; 88: 116–21.
2.
EllmanH. Diagnosis and treatment of incomplete rotator cuff tears.Clin Orthop Relat Res1990; 254: 64–74.
3.
MillsteinES, SnyderSJ. Arthroscopic management of partial, full-thickness, and complex rotator cuff tears: indications, techniques, and complications.Arthroscopy2003; 19(Suppl 1): 189–99.
4.
ConwayJE. Arthroscopic repair of partial-thickness rotator cuff tears and SLAP lesions in professional baseball players.Orthop Clin North Am2001; 32: 443–56.
5.
UchiyamaY, HamadaK, KhruekarnchanaP. Surgical treatment of confirmed intratendinous rotator cuff tears: retrospective analysis after an average of eight years of follow-up.J Shoulder Elbow Surg2010; 19: 837–46.
6.
WeberSC. Arthroscopic debridement and acromioplasty versus mini-open repair in the treatment of significant partial-thickness rotator cuff tears.Arthroscopy1999; 15: 126–31.
BartolozziA, AndreychikD, AhmadS. Determinants of outcome in the treatment of rotator cuff disease.Clin Orthop Relat Res1994; 308: 90–7.
9.
DinnesJ, LovemanE, McIntyreL, WaughN. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review.Health Technol Assess2003; 7: iii, 1–166.
10.
TeefeySA, RubinDA, MiddletonWD. Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases.J Bone Joint Surg Am2004; 86-A: 708–16.
11.
SmithCD, CornerT, MorganD, DrewS. Partial thickness rotator cuff tears: what do we know?Shoulder Elbow2010; 2: 77–82.
12.
SnyderSJ. Shoulder artrhoscopy.2nd edition.Philadelphia: Lippincott Williams & Wilkins, 2003.
13.
FukudaH, HamadaK, NakajimaT. Partial-thickness tears of the rotator cuff. A clinicopathological review based on 66 surgically verified cases.Int Orthop1996; 20: 257–65.
14.
HabermeyerP, KrieterC, TangKL, LichtenbergS, MagoschP. A new arthroscopic classification of articular-sided supraspinatus footprint lesions: a prospective comparison with Snyder's and Ellman’ classification.J Shoulder Elbow Surg2008; 17: 909–13.
15.
FukudaH. Partial-thickness rotator cuff tears: a modern view on Codman's classic.J Shoulder Elbow Surg2000; 9: 163–8.
16.
GschwendN, Ivosevic-RadovanovicD, PatteD. Rotator cuff tear – relationship between clinical and anatomopathological findings.Arch Orthop Trauma Surg1988; 107: 7–15.
17.
GotohM, HamadaK, YamakawaH, InoueA, FukudaH. Increased substance P in subacromial bursa and shoulder pain in rotator cuff diseases.J Orthop Res1998; 16: 618–21.
18.
BrownlowHC, SmithC, CornerT, NeenD, PenningtonR. Pain and stiffness in partial-thickness rotator cuff tears.Am J Orthop (Belle Mead NJ)2009; 38: 338–40.
19.
BryantL, ShnierR, BryantC, MurrellGA. A comparison of clinical estimation, ultrasonography, magnetic resonance imaging, and arthroscopy in determining the size of rotator cuff tears.J Shoulder Elbow Surg2002; 11: 219–24.
20.
AttarianDE. The derotation sign for perioperative diagnosis of significant partial-thickness rotator cuff tears.Arthroscopy2002; 18: 284–6.
21.
McConvilleOR, IannottiJP. Partial-thickness tears of the rotator cuff: evaluation and management.J Am Acad Orthop Surg1999; 7: 32–43.
22.
SmithC, DattaniR, DeansV, DrewS. The sourcil sign: a useful finding on plain X-ray?Shoulder Elbow2010; 2: 9–12.
23.
NakagawaS, YonedaM, HayashidaK, WakitaniS, OkamuraK. Greater tuberosity notch: an important indicator of articular-side partial rotator cuff tears in the shoulders of throwing athletes.Am J Sports Med2001; 29: 762–70.
24.
NakagawaS, YonedaM, MizunoN. Throwing shoulder injury involving the anterior rotator cuff: concealed tears not as uncommon as previously thought.Arthroscopy2006; 22: 1298–303.
25.
ItoiE, TabataS. Rotator cuff tears in anterior dislocation of the shoulder.Int Orthop1992; 16: 240–4.
BakerKS, GilulaLA. The current role of tenography and bursography.AJR Am J Roentgenol1990; 154: 129–33.
29.
WienerSN, SeitzWHJr. Sonography of the shoulder in patients with tears of the rotator cuff: accuracy and value for selecting surgical options.AJR Am J Roentgenol1993; 160: 103–7.
30.
de JesusJO, ParkerL, FrangosAJ, NazarianLN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis.AJR Am J Roentgenol2009; 192: 1701–7.
31.
VinsonEN, HelmsCA, HigginsLD. Rim-rent tear of the rotator cuff: a common and easily overlooked partial tear.AJR Am J Roentgenol2007; 189: 943–6.
32.
ReinusWR, ShadyKL, MirowitzSA, TottyWG. MR diagnosis of rotator cuff tears of the shoulder: value of using T2-weighted fat-saturated images.AJR Am J Roentgenol1995; 164: 1451–5.
33.
QuinnSF, SheleyRC, DemlowTA, SzumowskiJ. Rotator cuff tendon tears: evaluation with fat-suppressed MR imaging with arthroscopic correlation in 100 patients.Radiology1995; 195: 497–500.
LeeSY, LeeJK. Horizontal component of partial-thickness tears of rotator cuff: imaging characteristics and comparison of ABER view with oblique coronal view at MR arthrography initial results.Radiology2002; 224: 470–6.
36.
VandevenneJE, VanhoenackerF, Mahachie JohnJM, GelinG, ParizelPM. Fast MR arthrography using VIBE sequences to evaluate the rotator cuff.Skeletal Radiol2009; 38: 669–74.
37.
MeisterK, ThesingJ, MontgomeryWJ. MR arthrography of partial thickness tears of the undersurface of the rotator cuff: an arthroscopic correlation.Skeletal Radiol2004; 33: 136–41.
38.
FukudaH, HamadaK, NakajimaT, TomonagaA. Pathology and pathogenesis of the intratendinous tearing of the rotator cuff viewed from en bloc histologic sections.Clin Orthop Relat Res1994; 304: 60–7.
39.
FukudaH, MikasaM, OgawaK, YamanakaK, HamadaK. ‘The color test’: an intraoperative staining test for joint-side rotator cuff tearing and its extension.J Shoulder Elhow Surg1992; 1: 86–90.
40.
OglesbyJW. Modification of technique by Fukuda et al. [letter].J Shoulder Elbow Surg1992; 1: 226.
41.
TamaiK, HigashiA, ChoS, YamaguchiT. Chondrolysis of the shoulder following a ‘color test’-assisted rotator cuff repair – a report of 2 cases.Acta Orthop Scand1997; 68: 401–2.
42.
NakagawaY, UeoT, MikiT. Glenohumeral osteoarthritis following a ‘color test’ during rotator cuff repair. A case report and a review of the literature.Bull Hosp Joint Dis1998; 57: 216–18.
43.
LoIK, GonzalezDM, BurkhartSS. The bubble sign: an arthroscopic indicator of an intratendinous rotator cuff tear.Arthroscopy2002; 18: 1029–33.
44.
CordascoFA, BackerM, CraigEV, KleinD, WarrenRF. The partial thickness rotator cuff tear: is acromioplasty without repair sufficient?Am J Sports Med2002; 30: 257–60.
45.
LiemD, AlciS, DedyN. Clinical and structural results of partial supraspinatus tears treated by subacromial decompression without repair.Knee Surg Sports Traumatol Arthrosc2008; 16: 967–972.
46.
LoIK, BurkhartSS. Transtendon arthroscopic repair of partial thickness articular surface tears of the rotator cuff.Arthroscopy2004; 20: 214–20.
47.
KamathG, GalatzLM, KeenerJD. Tendon integrity and functional outcome after arthroscopic repair of high-grade partial thickness-supraspinatus tears.J Bone Joint Surg Am2009; 91: 1055–62.
48.
PoratS, NottageWM, FouseMN. Repair of partial thickness rotator cuff tears: a retrospective review with minimum two-year follow-up.J Shoulder Elbow Surg2008; 17: 729–31.
