Arthroscopy by Pietro Randelli David Dejour C. Niek van Dijk Matteo Denti & Romain Seil

Author:Pietro Randelli, David Dejour, C. Niek van Dijk, Matteo Denti & Romain Seil
Language: eng
Format: epub
Publisher: Springer Berlin Heidelberg, Berlin, Heidelberg

Classification of muscle atrophy according to Thomazeau [46]

Stage 1

Normal/slight atrophy occupation ratio (1.00–0.60)

Stage 2

Moderate atrophy occupation ratio (0.60–0.40)

Stage 3

Severe atrophy occupation ratio (<0.40)

Basically, degenerative changes are reversible until a certain critical “point of no return”. For SSP muscle atrophy this critical point is achieved when the muscle belly is below a tangent line drawn from the top of the coracoid base to the scapular spine (= tangent sign according to Zanetti [52]). The risk for RC irreparability or RC retear is directly correlated to the grade of muscle atrophy. Again, speed of atrophy progression varies, but is directly correlated to the number of tendons torn. The subscapularis as the strongest RC muscle tends to atrophy more quickly. It could be shown that over a 4-year follow-up period in patients with massive RCT refusing surgery, both muscle atrophy and fatty infiltration together with osteoarthritic changes increased [53]. Whereas shoulder function was stable, four out of eight patients with a primary reconstructable RCT showed an irreparable situation at the final follow-up.

Moosmayer et al. [29] observed clinical deterioration of 36 % of initially asymptomatic full-thickness tears within 3 years. Progression of tear size, muscle atrophy and fatty infiltration were correlated directly with the presence of symptoms.

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