Hamada classification of massive rotator cuff tears

Last revised by Rohit Sharma on 1 Jul 2024

The Hamada classification divides the x-ray features of massive rotator cuff tears into five grades. Subsequently, Walch subdivided grade 4 into two subtypes 1,2.

Classification

Hamada classification with Walch modification of rotator cuff tear arthropathy 1,3:

  • grade 1: acromiohumeral interval ≥6 mm; normal glenohumeral joint

  • grade 2: acromiohumeral interval ≤5 mm; normal glenohumeral joint

  • grade 3: acromiohumeral interval ≤5 mm, with acetabulization of acromion; normal glenohumeral joint

  • grade 4

    • grade 4a: glenohumeral osteoarthritis without acetabulization, acromiohumeral interval <7 mm

    • grade 4b: glenohumeral osteoarthritis with acetabulization, acromiohumeral interval ≤5 mm

History and etymology

Hamada et al. first described radiographic findings of massive rotator cuff tears in 1990 1,2. In 2005, Walch divided the Hamada grade 4 classification into two subtypes for patients who had glenohumeral narrowing without acromial acetabulization 3.

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