Critical zone tear

Last revised by Dr Joachim Feger on 28 Nov 2021

A critical zone tear refers to a rotator cuff tear in the critical zone of the rotator cuff, described approximately 8-20 mm proximal of the insertion site.

Common in adults and older people not so common in children and adolescents 2.

The clinical manifestation is wide-ranging, varying from mild distress to reduced throwing speed, chronic pain, and inability to move the shoulder.

Rotator cuff tears in the 'critical zone' are characterized by an intact insertional tendon stump. They can come in the full spectrum of possible rotator cuff tears: full-thickness, partial-thickness, intrasubstance, articular-sided, bursal-sided with or without intratendinous extensions.  

Most critical zone tears are thought to be multifactorial in nature: degenerative and traumatic-related tears occur there. From its location, the zone is affected most by subacromial impingement and there is a debate about the vascularity in that specific location. Some newer theories promote a view of relative hypovascularity in the stage of tendinosis, hypervascularity in strain and smaller partial-thickness tears and again hypovascularity in full-thickness tears 3.

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