Case 13 :
Diagnosis please:
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Supraspinatus tear with retraction

There is an area of relative avascularity a cm proximal to the point of insertion into the greater tuberosity. In addition, there is a relatively avascular area in the biceps tendon. This has been described as a critical zone. Therefore, attrition, chronic irritation, and inflammatory processes could result in weakening of these structures, leading to complete tears. Progressively, as the tendinous portion of the Rotator cuff becomes thin or torn, the Rotators allow the deltoid to pull the humerus against the under surface of the acromion, thereby leading to more impingement and tearing. In very large and chronic tears, the tendon may be put at risk and is often found deficient at the time of surgery.
Impingement syndrome has been classified into three stages:
Stage I: Oedema and haemorrhage
Stage II: Further inflammatory changes with fibrosis and thickening of the biceps tendon
Stage III: Disease eventually evolves into complete thickness tears of the rotator cuff.

Dr. Ashok Raghavan, Manipal Hospital, Bangalore



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