Critical zone tear
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A critical zone tear is referred to as 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 shoulder inability to move.
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.
- 1. Tawfik A. Rotator Cuff Disorders: How to Write a Surgically Relevant Magnetic Resonance Imaging Report? WJR. 2014;6(6):274. doi:10.4329/wjr.v6.i6.274
- 2. Zbojniewicz A, Maeder M, Emery K, Salisbury S. Rotator Cuff Tears in Children and Adolescents: Experience at a Large Pediatric Hospital. Pediatr Radiol. 2014;44(6):729-737. doi:10.1007/s00247-014-2875-6
- 3. Hegedus E, Cook C, Brennan M, Wyland D, Garrison J, Driesner D. Vascularity and Tendon Pathology in the Rotator Cuff: A Review of Literature and Implications for Rehabilitation and Surgery. Br J Sports Med. 2009;44(12):838-847. doi:10.1136/bjsm.2008.053769
- 4. Franceschi F, Papalia R, Del Buono A, Maffulli N, Denaro V. Repair of Partial Tears of the Rotator Cuff. Sports Med Arthrosc. 2011;19(4):401-408. doi:10.1097/jsa.0b013e3182393fa1