Partial Articular-sided Supraspinatus Tendon Tear/avulsion (pasta)

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Partial Articular-sided Supraspinatus Tendon Tear/avulsion (pasta)

Authors, Editors, Case Information Author: Steven Gawrys, DO Affiliation: University of Florida Co Author(s): Christian Prat B.S. Manuel Britto M.D. Senior Editor: Derek Stokes, MD Clinical Vignette: A 39-year-old male presented with 3 years of left shoulder pain without a specific mechanism of injury or history of surgery. Pain was localized to the anterolateral aspect of the left shoulder and was exacerbated by overhead and reaching movements. His physical exam was significant for left shoulder abduction strength 5-/5 and a positive O'Brien test. Symptoms were refractory to formal therapy, guided home exercises, Tylenol, and NSAIDs. He had also received 2 prior subacromial bursa corticosteroid injections and one leukocyte-poor platelet rich plasma injection with only short-term symptom relief. He endorsed continued difficulty performing his work and activities of daily living. Type of Probe Used: Linear transducer at 10Hz. Unlabeled Short Axis View of the Anterior Supraspinatus Tendon Unlabeled short axis view of the anterior supraspinatus tendon. Labeled Short Axis View of the Anterior Supraspinatus Tendon Labeled short axis view of the anterior supraspinatus tendon with a small anechoic defect at the insertion, lateral to the long head of biceps tendon consistent with a partial-thickness partial-width articular sided supraspinatus tendon tear. Unlabeled Long Axis View of the Anterior Supraspinatus Tendon Unlabeled long axis view of the anterior supraspinatus tendon. Labeled Long Axis View of the Anterior Supraspinatus Tendon Labeled long axis view of the anterior supraspinatus tendon with a small anechoic defect at the insertion consistent with a partial-thickness partial-width articular sided supraspinatus tendon tear. Unlabeled Long Axis View of the Posterior Supraspinatus Tendon Unlabeled long axis view of the posterior supraspinatus tendon. Labeled Long Axis View of the Posterior Supraspinatus Tendon Labeled long axis view of the posterior supraspinatus at the articular surface with increased thickness of the tendon (approximately 4.9 mm) and no discrete tears. Interpretation Image Interpretation: There is an anechoic defect at the anterior supraspinatus insertion to the articular surface of the humerus. This defect is a partial thickness and partial width. The defect is just lateral to the biceps tendon, which appears intact. The defect is isolated to the anterior fibers of the supraspinatus tendon. There does not appear to be any bursal effusion, and no cortical surface irregularity is noted. The posterior fibers of the supraspinatus tendon in the long axis are intact. Teaching Pearl: This case emphasizes the importance of deliberately visualizing the entire rotator cuff footprint, especially where the supraspinatus inserts on the articular surface of the greater tuberosity. PASTA lesions are common partial-thickness rotator cuff tears and may appear as a focal hypoechoic or anechoic articular-sided defect, often near the anterior supraspinatus adjacent to the biceps tendon. A complete shoulder ultrasound should also assess the biceps tendon, subscapularis, infraspinatus, and subacromial-subdeltoid bursa, because associated pathology may influence symptoms and treatment. MRI or MR arthrography remains useful when ultrasound findings are uncertain, intra-articular pathology is suspected, or red flag symptoms are present. References: 1. Yoon K, Kim H, Han SB, Song HS. Ultrasound findings aid decisions to repair partial articular supraspinatus tendon avulsion. J Ultrasound Med. 2020;39(10):2005-2011. doi:10.1002/jum.15307 2. Farooqi AS, Lee A, Novikov D, et al. Diagnostic accuracy of ultrasonography for rotator cuff tears: a systematic review and meta-analysis. Orthop J Sports Med. 2021;9(10):23259671211035106. doi:10.1177/23259671211035106 3. Roy JS, Braen C, Leblond J, et al. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med. 2015;49(20):1316-1328. doi:10.1136/bjsports-2014-094148
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Authors, Editors, Case Information

Unlabeled Short Axis View of the Anterior Supraspinatus Tendon

Labeled Short Axis View of the Anterior Supraspinatus Tendon

Unlabeled Long Axis View of the Anterior Supraspinatus Tendon

Labeled Long Axis View of the Anterior Supraspinatus Tendon

Unlabeled Long Axis View of the Posterior Supraspinatus Tendon

Labeled Long Axis View of the Posterior Supraspinatus Tendon

Interpretation

UPCOMING EVENTS

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