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Rotator Cuff Tears

Classification

  • 1. Impingement
  • 2. Rotator cuff tears
  • 3. Cuff Arthropathy
  • 4. Calcific Tendonitis
  • 5. Biceps tendonitis
  • The first three represent spectrum of disease & often present together
  • Neer divided into three groups
Neer's Classification of Rotator Cuff Tears
Group Description
1: Traumatic Tears
  • < 5% of 340 cases
  • < 40 years of age & result of microtrauma from overhead sports
2: Tears with Dislocations
  • Anterior dislocation
  • > 40 years & in rotator interval
  • Multidirectional instability
  • Cleft tear of rotator interval
  • Extreme violence at any age with large cuff tear maybe associated nerve injury
3. Impingement Tears
  • > 40 years
  • 50% no history of injury
  • Classification
    • 1. Partial thickness – joint side > bursal
    • 2. Full thickness
Classification of Rotator Cuff Tears
Partial / complete Description
Partial (Codman)
  • Bursal side
  • Joint side
  • Intrasubstance
Complete (Cofield)
  • Small < 1cm
  • Medium 1-3cm
  • Large 3-5cm
  • Massive > 5cm

Hospital for Special Surgery Classification System

Hospital for Special Surgery Rotator Cuff Tear Classification System
Tear Type Points
A = Partial thickness, articular surface  
B = Partial thickness, bursal surface  
C = Full thickness, complete  
Size (cm2)
No Tear   0
Small <2 1
Medium <6 2
Large <15 3
Massive >15 4
Retraction / Mobility
No retraction 0
Extracapsular Release required 1
Extra & Intracapsular release required 2
Unable to reapproximate tear to insertion site 3
Tissue Quality
Normal (normal cuff tissue surrounding tear) 0
Good (vascular, elastic, slightly thinned or frayed) 1
Fair (thin, frayed, vascular, holds structure well) 2
Poor (thin, shredded, avascular, brittle) 3
Surgeon's subjective assessment of Repair
Excellent  
Goood  
Fair  
Poor