Myotendinous junction tear of the anterior bundle of the supraspinatus muscle—a rare pattern of injury involving rotator cuff muscles (original) (raw)
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Supraspinatus rupture at the musculotendinous junction
Journal of Shoulder and Elbow Surgery, 1998
The vast majority of rotator cuff tears occur within the tendon or as an avulsion from the greater tuberosity. Supraspinatus injury at the musculotendinous junction is a very uncommon event. We describe a case of supraspinatus rupture at the musculotendinous junction, with successful conservative treatment. It occurred in a 23-year-old woman, the youngest patient with this uncommon type of injury. To our knowledge, this is the first case of rupture of the supraspinatus muscle at the musculotendinous junction in a young woman and the second in a woman.
MRI findings of rotator cuff myotendinous junction injury
AJR. American journal of roentgenology, 2014
The purpose of this article is to describe the MRI features of rotator cuff myotendinous junction injuries. We retrospectively identified MRI cases with myotendinous junction injury of the rotator cuff muscles and reviewed clinical, imaging, and surgical records. MR images were reviewed independently by two musculoskeletal radiologists to grade myotendinous junction injuries (strain, partial tear, or complete tear) and to assess for concurrent tendon tears (partial or full thickness) and bone changes (fracture or contusion). The final study group comprised 16 subjects. The mean age was 38 years, with a majority of men (56%). The left shoulder was affected in 56% of subjects, with the dominant upper limb affected in 50%. The mean time between symptoms and MRI was 19 days. Subjects reported heavy lifting (19%), landing on the arm after a fall (19%), or prior shoulder therapeutic injection (25%). Myotendinous junction injuries affected the infraspinatus muscle (50%), followed by the su...
Supraspinatus rupture at the musculotendinous junction in a young woman
Journal of Orthopaedics and Traumatology, 2013
The vast majority of rotator cuff tears occur within the tendon or as an avulsion from the greater tuberosity. Supraspinatus injury at the musculotendinous junction is a very uncommon event. We describe a case of supraspinatus rupture at the musculotendinous junction, with successful conservative treatment. It occurred in a 23-year-old woman, the youngest patient with this uncommon type of injury. To our knowledge, this is the first case of rupture of the supraspinatus muscle at the musculotendinous junction in a young woman and the second in a woman.
Supraspinatus rupture at the musclotendinous junction: an uncommonly recognized phenomenon
Journal of Shoulder and Elbow Surgery, 2012
Background: The majority of rotator cuff lesions involving the supraspinatus occur at or near the level of bone-tendon interface. We present a series of supraspinatus injuries at the musculotendinous junction. Methods: Between October 2002 and December 2009, we prospectively evaluated all patients presenting with an injury of the supraspinatus at the musculotendinous junction. Results: Five patients (1 female and 4 males) were identified. Three patients had a clear history of trauma. All patients presented acutely with pain and muscular edema on T2 magnetic resonance imaging (MRI) sequences. Lesions were characterized as stretch injuries in 2 cases and complete rupture at the level of the musculotendinous junction in 3 cases. Electrodiagnostic studies were normal in all cases. All patients were treated nonoperatively. On clinical and radiological examination at an average of 24 AE 10 months (range, 10-38), 1 patient had complete clinical and radiological resolution, 1 improved, and 3 who complained of loss of function demonstrated severe fatty infiltration on MRI. Conclusion: Musculotendinous rupture of the supraspinatus is an unusual lesion of the rotator cuff. With incomplete injuries, recovery can be anticipated with nonsurgical management. However, in the case of a complete rupture with muscle retraction, nonoperative management leads to unsatisfactory outcomes.
Acta Medica Academica, 2019
Objective. Acute inferior subscapularis myotendinous junction injuries are occasionally seen in overhead throwing athletes, and can present with posterior shoulder pain.Case Reports. Four professional baseball pitchers presented with acute onset of posterior shoulder pain while pitching. After thorough, routine physical examination of the shoulder by the referring orthopaedic surgeon magnetic resonance imaging (MRI) was performed within 7-10 days of the onset of presenting symptoms and interpreted in consensus by 2 fellowshiptrained musculoskeletal radiologists with 9 and 5 years of experience and a musculoskeletal radiology fellow. The patients were then treated conservatively for subscapularis musculotendinous injuries and clinically assessed for symptom resolution before they were allowed to return to play.Conclusion. Inferior subscapularis myotendinous junction injuries should be included in the differential diagnosis of baseball pitchers with posterior shoulder pain.
Variation of Myotendinous Junction with Muscle's Tensile Strength: A Case Report
International Journal of Cadaveric Studies and Anatomical Variations, 2023
Myotendinous Junction is the transition zone between the muscle and its tendon. Hence, it is subjected to immense stress within the muscle. It is hypothesized that muscles used for more stressful actions should have a more arranged myotendinous junction compared to muscles which are used less. Cadaveric specimens of MTJ from Plantaris, Gastrocnemius, Soleus muscles have been observed under the microscope and compared, the results were found to be consistent with the hypothesis.
Two Techniques for Treating Medium-Sized Supraspinatus Tears
Jbjs Essential Surgical Techniques, 2021
Background:Arthroscopic rotator cuff repair emerged in the early 1990s, and the single-row repair technique (i.e., suture anchor[s] set at the center or laterally on the greater tuberosity) has shown promising outcomes; however, the healing rate of the repaired cuff is suboptimal. Although small to medium-sized rotator cuff tears have shown better clinical outcomes and structural healing than larger tears, healing failure still occurs1.There are several factors that affect rotator cuff healing. The initial stiffness and strength of the repair, gap formation resistance, footprint coverage at the end of surgery, vascularity of the cuff, and mechanical stress on the repaired cuff are important factors2. To improve tendon-to-bone healing, 2 repair techniques have been developed: the suture bridge technique and the medially based single-row technique. The suture bridge technique involves placing anchors in a 2-row fashion, with medial-row sutures from the medial anchors bridged over the footprint with lateral-row knotless anchors3. The single-bridge technique has shown biomechanical superiority in terms of ultimate strength, stiffness, and gap formation resistance4; however, these outcomes are achieved at the cost of relatively high tension at the suture-cuff junction, as well as interference with vascularity at the medial mattress sutures if medial mattress sutures are tied.Alternatively, the medially based single-row technique was proposed as a modification of the laterally based (traditional) single-row technique5. This technique is combined with the creation of bone marrow vents (microfracture technique) lateral to the inserted anchor in the footprint to promote soft-tissue regeneration (called “neotendon”) over the exposed footprint. The theoretical advantages of this technique include lower tension on the repaired cuff; better screw purchase beneath the subchondral bone, which avoids weaker cancellous bone on the peripheral area of the greater tuberosity; and avoidance or reduction of lateral shift of the muscle-tendon junction. However, these outcomes are achieved with relatively weaker initial fixation strength and by exposing the uncovered greater tuberosity footprint lateral to the repaired tendon edge.Both procedures provide equivalent outcomes as measured by functional and pain scores. At present, there is no decisive superiority in treating small to medium-sized supraspinatus tears.Description:Arthroscopic subacromial decompression is performed in both techniques.For suture bridge fixation, the suture anchor is placed at the articular margin of the humeral head as the medial row, and both limbs of each suture are passed through the tendon approximately 5 mm lateral to the muscle-tendon junction of the rotator cuff in a mattress fashion. After the medial-row knots are tied, the suture limbs are brought into 2 lateral push-in anchors.For the medially based single-row repair, suture anchors are placed lateral to the articular margin. Each suture limb is passed through the tendon approximately 1 cm medial to the torn edge of the cuff. All sutures are tied with 7 half-hitches, avoiding a sliding knot.Alternatives:Open or mini-open rotator cuff repair6.Arthroscopic rotator cuff repair suture bridge technique without knot-tying7.Arthroscopic transosseous (i.e., anchorless) rotator cuff repair8.Rationale:The suture bridge technique has achieved better mechanical properties and footprint coverage, and the medially based single-row technique has achieved lower tension on the repaired construct with neotendon regeneration. These techniques are the opposite concept as coverage-oriented and tension-oriented techniques, respectively. To our knowledge, there is presently no study showing that either of these 2 techniques is better than the other4. With that said, the author prefers the medially based single-row technique in cases with degenerative tendon tissue, especially among elderly patients with relatively short tendon substance and with preoperative stiffness because lowering the tension on the repaired construct would be more important than coverage of the greater tuberosity.Expected Outcomes:Published data have not shown significant differences in the clinical outcomes and cuff integrity between these 2 techniques, with no decisive superiority when treating small to medium-sized supraspinatus tears. The choice between these techniques is solely the decision of the surgeon; however, medial cuff failure has been reported only when using the suture bridge technique, and incomplete healing was more frequent among medially based single-row techniques. One should consider the risks of medial cuff failure and incomplete healing of the repaired cuff before choosing the repair technique for medium-sized supraspinatus tears.Important Tips:The proposed risk factors for medial cuff failure in the suture bridge technique include:○ A mattress suture configuration placed at the muscle-tendon junction○ Aggressive rehabilitation○ Use of a large-diameter suture passer○ Application of a sliding knot○ High-stress concentration around the medial knotsThe proposed risk factors for incomplete healing in the medially based single-row techniqueare:○ Lower mechanical properties (initial stiffness and strength, gap formation resistance) in the repaired site○ Lower number of sutures