Post by steve172510 on Apr 7, 2018 12:26:36 GMT -6
On an uncontrasted MRI, I understand No UCL tear being visualized and a complete tear being visualized. My question is, with a partial tear that is clearly seen on an uncontrasted MRI there seems to be a wide range of interpretation by various providers (radiologist, ortho, etc) on the degree or “percentage” of partial tear. So much variability that I question is this something can even be accurately assessed (% of tear)? Can anyone comment on that from their experience?
1st - you should request the radiologist's written report for your MRI.
Last year, I had surgery for a rotator cuff tear of the supraspinatus tendon, one of the most common rotator cuff injuries. I tried to understand what I was being told about the injury and MRI results, asked questions, sat with the radiologist for a personal explanation and also spoke to my surgeon briefly. I am still confused by the terminology and do not have a clear picture of my injury. My diagnosis was a "small full thickness tear" of the supraspinatus tendon.
1) I can picture a complete separation of the tendon from the bone. That is, a complete tear of the tendon so that the muscle no longer has any attachment.
2) I can't picture what my injury would look like. Internet pictures show clear pictures labeled as "full thickness tears" as if the tear were a knife cut through all of the tendon thickness and some but not all of the tendon width. Search: full thickness tear supraspinatus tendon pictures
But then I started considering tendon detachment from the bone. The concept of tendon-to-bone footprint enters the picture. For example, if the tendon were attached to the bone over a 'footprint' area of about 1 square inch and 30% of that area had detached from the bone, what would that be called? Is that also a 'full thickness tear'? A footprint does not look like the "full thickness" tears shown in most internet pictures or to anything in the MRI shown to me by my radiologist. I could not see the tear in the MRI or understand what I was looking for, but in any case the MRI did not match up to the picture that the radiologist showed me as typical of a 'full thickness tear, similar to the internet pictures. I asked my surgeon and believe that my surgery did involve reattaching a percentage of my tendon to the bone and leaving the still attached percentage of tendon intact. That was my understanding.
It is difficult to show an illustration of a tendon-bone separation involving a percentage of the tendon attachment from the bone. Maybe most internet pictures do not show the attachment area itself. ?
In summary, I am most confused about the width of the tendon that is torn for a 'full thickness tear' and how separation of the tendon from the bone is described in this terminology.
I believe that there is uncertainty in MRI interpretations. In my case, the hospital where the surgery was performed required that hospital radiologists also examine my MRI. There were some differences between the two written reports but the main diagnosis, important for the surgery, was the same. Surgery confirmed the diagnosis.
This information is as best I can recall, check the facts. Before surgery - for my specific surgery - I learned that this diagnosis is very important for predicting outcomes for a successful surgery. Partial thickness tears may be treated with more success without surgery. Full thickness tears much less so. My 'small' tear was estimated at "10 mm". But 10 mm or less was 'small' and greater than 10 mm was 'large' I believe. Borderline? For a small tear of the supraspinatus tendon, outcomes for my open surgery were estimated as 95% successful; but for 'large' tears the outcomes were estimated as 80% successful. The size ranges for 'small' and 'large' were considerable so these are very approximate success estimates. For yet larger severe tears the percentage for successful outcomes was considerably lower. Repeat surgeries would have considerably less percentage of successful outcomes.
I was told that I could play tennis with my injury but that it was likely that the tear would increase in size. Considering the percentages for successful outcomes vs size, I wanted the surgery while the tear was still small.
Right after surgery my surgeon said that it was a small tear and should heal quickly. When I saw my surgeon before the surgery it was brief and I could not get a picture of my specific injury. After surgery it was some time later. I don't think my surgeon could remember the details of each surgery that he did that day. The surgery report has some details but did not give me a visualization of my injury.
I found some internet pictures showing reattaching tendons to bones that showed heavy threads holding the tendon to the bone. My surgery included those type threads.
I tried researching the terminology used for tears - interpretations for my injury were ambiguous - and I still don't have the picture of my injury.
My surgery was successful. Recover was slow, 6 months of increasing & maintaining range of motion, then increasing strength, then at 9 months back to normal activity gradually. It feels normal but I still have to get back to tennis.
Last Edit: Apr 8, 2018 9:06:35 GMT -6 by chastennis
Post by Glenn Fleisig, Ph.D. on Apr 9, 2018 12:45:19 GMT -6
Chas has provide valuable, first-hand insight.
As you have both commented, interpretation of the percentage or severity of a partial tear is subject to much more interpretation than a full tear or no tear.
If you can provide more specifics about your interest, I can get someone to post a response. Are you (or your son) a baseball pitcher? What did your physician or medical report say about your partial tear? What course(s) of treatment did you and your physician discuss?