Small Tears Research Articles

Blood flow evaluation by dynamic magnetic resonance imaging of symptomatic rotator cuff tears and frozen shoulders

This study compared imaging findings of blood flow changes between symptomatic rotator cuff tear (RCT) and frozen shoulder (FS) by using 3-dimensional dynamic magnetic resonance imaging (MRI) to determine the clinical characteristics of symptomatic RCT. The 2 study groups comprised 31 symptomatic RCT patients who underwent arthroscopic rotator cuff repair and 30 patients with FS. We denoted abnormal blood flow detected around the glenohumeral joint as the burning sign (BS). We evaluated the characteristics of dynamic MRI and compared them between BS-positive and BS-negative patients in the RCT group. All members of the FS group showed the BS. Conversely, the incidence of the BS in RCT patients was 53% (16 of 31). The BS in RCT and FS patients was observed in the rotator interval in 16 shoulders, in the axillary pouch in 3 shoulders (P < .01), and in the intertubercular groove in 10 RCT and 12 FS patients. In the RCT group, 16 patients with BS had a statistically significantly higher Numeric Rating Score at rest (P = .0005) and in motion (P = .04) than the 15 patients without BS and exhibited a higher rate of small and medium tears and a higher rate of shoulder contracture. Dynamic MRI of symptomatic RCT (53.3%) highlighted abnormal vascularization around the glenohumeral joint, which may be associated with pain and contracture in RCT as in FS.

Reconstruction of small and medium rotator cuff tear with single row anchor under all-arthroscopy

Objective To investigate the clinical efficacy of single row anchor under all-arthroscopy in the treatment of small and medium rotator cuff tear. Methods From January 2014 to December 2016, 13 cases of shoulder pain and activity limitation were diagnosed as shoulder rotator cuff tear after excluding other shoulder diseases by preoperative symptoms, signs, imaging examination. The rotator cuff tear size was further confirmed during the operation. Under all-arthroscopy, the single row anchor was used to reconstruct the rotator cuff tear. After the operation, the California University shoulder score system (UCLA) was used for the follow-up. Results All the wounds achieved primary healing. No joint infection and nerve injury occurred. According to imaging examination, there was no slippage of the anchor and recurrence of rotator cuff tear. The follow-up time ranged from 6 to 36 months with an average of 23 months. The postoperative pain symptoms were relieved effectively, and the shoulder function recovered well. According to the UCLA score system, the results were rated as excellent in 10 cases, good in 2 cases and poor in 1 case. The rate of patient satisfaction was 100%. Conclusion Arthroscopic single row anchor for reconstruction of small and medium rotator cuff tear has the advantages of simple operation, small trauma, short operation time, light postoperative pain, quick function recovery, relatively low cost. It is an ideal treatment method for repair of such injuries. Key words: Shoulder joint; Arthroscopes; Rotator cuff injury; Single row anchor

Optimization and histological validation of DMEK graft preparation with specific instruments

Abstract Purpose To assess the learning curve and technique standardization of Descemet membrane endothelial keratoplasty (DMEK) preparation with a purpose-specific instruments at The Basque Transfusion and Human Tissue Centre. Methods Twenty corneas not eligible for transplantation from 18 donors were prepared by an eye bank technician without previous surgical experience. The technique was monitored and standardized and three differentiated steps were characterized: “cleaning”, “stripping” and “pulling”. Preparation time, number of tears at every stage of the technique and donor demographics were measured. Tissue damage was catagorized into five graft morphological types. To evaluate microscopic tissue damage, electron microscopy images were taken from three pre-specified areas of the donor cornea: graft periphery, trabecular meshwork and denuded stroma. Results Viable grafts resulted in 14 out of the 20 preparations. A positive trend was found between graft usability and the experience of the operator. Small peripheral round tears were the most common findings overall and in the viable grafts subset. Radial and round tears occurred most frequently during the stripping and the cleaning phase, respectively. Univariate analyses showed no correlation between preparation time, donor age and gender and culture medium. Conclusion DMEK preparation with a purpose-specific instruments may have a relatively short learning curve, suggesting feasibility for eye bank technicians without previous surgical experience.

53-Year-Old Man With Progressive Dyspnea and Orthopnea

53-Year-Old Man With Progressive Dyspnea and Orthopnea

Laparoscopic salpingectomy and removal of Essure hysteroscopic sterilisation device: a case series

Objectives: Tubal sterilisation using Essure is a minimally invasive technique for permanent contraception, with high rates of patient satisfaction. However, some women subsequently choose removal of the inserts, due to side effects such as pelvic pain, abnormal bleeding, dyspareunia or allergic dermatitis. This case series presents the management of eight women who underwent laparoscopic removal of Essure inserts in conjunction with salpingectomy. We describe our surgical technique, its underlying principles and immediate surgical outcomes.Methods: Eight patients were identified as having undergone removal of Essure inserts, via an electronic search of the surgical procedures database. A retrospective review of case records was undertaken. The primary outcome was safety and feasibility of the laparoscopic salpingectomy approach. Secondary outcome measures included implant fracture rate, operative time, blood loss and length of patient stay.Results: All eight women were able to undergo laparoscopic salpingectomy and removal of the Essure inserts without the need for laparotomy or hysterectomy. There were no incidences of fracture or incomplete removal of the insert. Immediate postoperative recovery was uncomplicated in all eight women; the mean length of stay was 17 h. One patient had a small bowel serosal tear attributed to laparoscopic entry.Conclusion: This case series suggests that laparoscopic salpingectomy for removal of Essure inserts is safe and feasible. We acknowledge that the numbers were small. However, consistent use of a laparoscopic approach in these eight patients indicates that this procedure is a feasible and suitable alternative to hysterectomy.

Differential Deposition of Fluorescently Tagged Cholesterol on Commercial Contact Lenses Using a Novel In Vitro Eye Model.

PurposeWe evaluate the differences in lipid uptake and penetration in daily disposable (DD) contact lenses (CL) using a conventional “in-vial” method compared to a novel in vitro eye model.MethodsThe penetration of fluorescently labelled 22-(N-(7-Nitrobenz-2-Oxa-1,3-Diazol-4-yl)Amino)-23,24-Bisnor-5-Cholen-3beta-Ol (NBD)–cholesterol on three silicone hydrogel (SH) and four conventional hydrogel (CH) DD CLs were investigated. CLs were incubated for 4 and 12 hours in a vial, containing 3.5 mL artificial tear solution (ATS), or were mounted on an in vitro eye-blink platform designed to simulate physiologic tear flow (2 mL/24 hours), tear volume and “simulated” blinking. Subsequently, CLs were analyzed using laser scanning confocal microscopy and ImageJ.ResultsPenetration depth and fluorescence intensities of NBD-cholesterol varied between the incubation methods as well as lens materials. Using the traditional vial incubation method, NBD-cholesterol uptake occurred equally on both sides of all lens materials. However, using our eye-blink model, cholesterol penetration was observed primarily on the anterior surface of the CLs. In general, SH lenses showed higher intensities of NBD-cholesterol than CH materials.ConclusionsThe traditional “in-vial” incubation method exposes the CLs to an excessively high amount of ATS, which results in an overestimation for cholesterol deposition. Our model, which incorporates important ocular factors, such as intermittent air exposure, small tear volume, and physiological tear flow between blinks, provides a more natural environment for in vitro lens incubation.Translational RelevanceIn vitro measurements of CLs are a common approach to predict their interactions and performance on the eye. Traditional methods, however, are rudimentary. Therefore, this study presents a novel in vitro model to evaluate CLs, which consequently will enhance elucidations of the interactions between CLs and the eye.

Location and thickness of delaminated rotator cuff tears: cross-sectional analysis with surgery record review

BackgroundTo facilitate better treatment, we analyzed morphologic features of delamination from the viewpoint of the location of delamination and the thickness of each layer.Materials and MethodsOf 270 shoulders that consecutively underwent arthroscopic rotator cuff repair, 210 were included. During the operation, the surgeon assessed the size of the rotator cuff tear, determined the presence and location of delamination, and compared the thickness between superficial and deep layers if delamination was present. Immediately after the operation, the surgeon wrote down the data in the record form. The authors retrospectively referred to these surgical records to investigate those items.ResultsDelamination was found in 111 of 210 shoulders. The overall preoperative Constant score did not significantly differ between the 2 groups. In terms of the location, 7.2% cases had delamination in the anterior part, 74.8% in the posterior part, and 18.0% in both parts (Fleiss κ = 0.9). The larger the rotator cuff tear, the more frequently the delamination was limited to the posterior part (trend P = .001). As for layer thickness comparison, 40.0% of the shoulders with small tears, 38.8% with medium tears, 66.0% with large tears, and 80.0% with massive tears had a thicker deep layer than superficial layer (Fleiss κ = 0.9). The larger the size of the rotator cuff tear, the more frequently the deep layer was thicker than the superficial layer (trend P = .001).ConclusionsThe larger the rotator cuff tear, the more carefully shoulder surgeons should observe and treat the posterior and deep part of delamination.

The CT shows aneurysmal dilatation of the ascending aorta with a small intimal tear in the anterior aspect of the mid-ascending aorta

The CT shows aneurysmal dilatation of the ascending aorta with a small intimal tear in the anterior aspect of the mid-ascending aorta

Evaluation and management of small dural tears in primary lumbar spinal decompression and discectomy surgery

Incidental dural tear is one of the most common intraoperative complications in lumbar spine surgery. Yet, its technical management for the prevention of CSF leak is controversial. The technique of managing dural tears depends on the location of the dural tears as well on the length and anatomical characteristics of the dural tear. We propose an anatomical classification for small (less than one cm) dural tears and report on the outcome of managing these dural tears types using different technique for different type.62 patients underwent spinal dural repair after microdiscectomy or lumbar spinal decompression. Group 1 consisted of 20 patients, with Type I or mild dural tear who had tissue-glue coated collagen sponge or fibrin glue application. Group 2 comprised 21 patients with Type II or moderate dural tear who had both tissue-glue coated collagen sponge and fibrin glue application. Group 3 comprised 21 patients with Type III or severe dural tear who had polypropylene suture and tissue-glue coated collagen sponge and/or fibrin glue application. Evident postoperative CSF leak was used to determine the patient’s postoperative result. Postoperative CSF leak was not evident during a minimum 1 year follow up in group 1. Internal CSF leak was evident in group 2 (n = 3) and group 3 (n = 3) during same follow up. Three patients underwent re-do spinal surgery for CSF leak repair. We recommend different management technique depending on the type of tear. For type I, we recommend the use of tissue-glue coated collagen sponge or fibrin glue application, without dural suturing.

Hot-Tearing Assessment of Multicomponent Nongrain-Refined Al-Cu Alloys for Permanent Mold Castings Based on Load Measurements in a Constrained Mold

The hot-tearing resistance of multicomponent Al-Cu alloys during permanent mold casting was investigated using a constrained permanent mold in which the load and temperature were measured. The nominal Cu composition was varied from 5 to 8 wt pct. Casting experiments were conducted without adding any grain-refining inoculants. The following variables, which were obtained from the measured load data during casting, were considered to assess the hot-tearing resistance of the Al-Cu multicomponent alloys: “V”-like signature in the load rate variation, load at solidus point, and load rate average over the freezing range. In addition, a hot-tearing criterion based on the variation of the fraction of solid in the late stages of solidification was used. It was found that all criteria considered can accurately predict the alloys with the lowest and highest hot-tear resistance, respectively. It was found that the rate of measured load during casting could be used to indicate substantial hot tearing. However, the load rate variation could not be used to detect when small hot tears were present. Among all the criteria considered, the load at the solidus point shows an excellent agreement with experimentally observed hot-tearing resistance for all but one alloy. The poorly resistant hot-tearing alloys exhibited mainly coarse columnar grains while the most hot-tearing resistant alloys exhibited a much more refined grain microstructure. This is the first study in which good hot-tear resistance is demonstrated for multicomponent Al-Cu alloys with nominal Cu content greater than 7 wt pct.

The Role of Biologic Therapy in Rotator Cuff Tears and Repairs.

The purpose of this review was to establish the foundation of the major biologic adjuvants to rotator cuff repairs and review recent scientific findings. Platelet-rich plasma (PRP) overall has no significant impact on functional outcomes and repair integrity, but may be more advantageous in small to medium tears. Further studies should focus on leukocyte-rich versus poor preparations and the use of PRP in patients that are high risk for repair failure. Biologic and synthetic patches or augments provide mechanical stability for large and massive rotator cuff tears and decrease re-tear rates. Mesenchymal stem cells have demonstrated improved healing rates without an impact on outcomes. Cytokines and growth factors show promise in animal models, but require human trials to further evaluate. In massive or revision repairs, allograft or synthetic patch augmentation should be considered. Platelet-rich plasma may have benefit in smaller tears. Further studies are needed to evaluate the value of mesenchymal stem cells and various cytologic chemical signals.

Factors Affecting Cost, Outcomes, and Tendon Healing After Arthroscopic Rotator Cuff Repair

The purpose of this study was to simultaneously examine costs, functional outcomes, and tendon healing after arthroscopic rotator cuff repair. This was a retrospective, single-surgeon, single-hospital study. Pre- and postoperative Simple Shoulder Test (SST), visual analog scale (VAS) pain, and American Shoulder and Elbow Surgeons (ASES) scores, and postoperative magnetic resonance images (MRIs) were obtained. Direct costs were derived using a unique, validated tool. Costs included overall total direct cost, which included facility use costs, medication costs, supply costs, and other ancillary costs. 85 patients had a minimum 1-year follow-up of functional outcomes (mean of 1.24years, range 1-3.2years) and 56 of 85 (66%) had postoperative MRI healing data at an average follow-up of 1.3years (range 1-3.2years). Increased direct cost was associated with ASA class III (P < .001) compared with ASA class I, procedures performed at the main operative room (P= .017) compared with those at the surgical center, single-row repair (P < .001) compared with double-row repair, medium and large tear sizes (P < .001 and P= .001) compared with small tear, and increased number of anchors (P ≤ .001 or P < .039 for each additional). Arthroscopic biceps tenodesis was associated with decreased improvement in SST, VAS-pain, and ASES scores (P < .001, .012, and .024), whereas infraspinatus atrophy and large/massive tear size was associated with decreased improvement in ASES scores (P= .03). Obesity (P= .004) and smoking (P= .034) were associated with greater improvement in VAS-pain scores as these were associated with decreased preoperative scores. Seventy percent of tears healed. Within our study, factors that increased direct costs were outcome neutral, and factors that improved outcome were cost neutral. Level IV, retrospective.

Transcleral approach for closing retinal tears using DuraSeal™ hydrogel sealant.

Purpose:The aim of this study was to evaluate an innovative approach for closing retinal tears using DuraSeal™ (DS) hydrogel sealant in a rabbit model.Methods:Retinal detachment with a small tear was performed on 20 New Zealand rabbits. Thereafter, rabbits were divided into two groups; the experimental group received a transscleral injection of 0.1 ml DS into the subretinal space whereas the control group received sham injection of saline. Eyes were clinically evaluated using indirect ophthalmoscopy, retinal function was recorded in ten rabbits by electroretinography and the sealant's toxicity was evaluated histopathologically.Results:We found that the DS hydrogel was easily injected transsclerally into the subretinal space of the detached retinas with no major complications. Retinal reattachment was seen in both groups within 2 weeks with no toxicity to the sensory retina. There were no significant differences in retinal function between groups.Conclusion:Subretinal injection of hydrogel through a transscleral route is easy to perform and may open a new avenue in the treatment of retinal detachment. However, the efficacy of the DS as a tamponade for sealing retinal tear is yet to be definite. Long-term clinical, functional, and toxicological studies are needed to evaluate its full potential for clinical applications.

Characteristics of the patients with delaminated rotator cuff tear

Purpose: The purpose of this study was to analyze factors relating to delamination in full-thickness rotator cuff tears.Methods: 126 patients with full-thickness rotator cuff tears treated by arthroscopic rotator cuff repair were the subjects of this study. There were 52 females and 74 males whose average age was 64.2 years. Fifty-three patients had history of trauma. The average duration of disorder was 29.5 weeks. Nineteen patients were diagnosed with diabetes. On types of the tears, small tear was observed in 59 patients, medium tear in 47 patients, large tear in 6 patients, and massive tear in 14 patients. The average size of tear was 1.98 cm. Delamination of the torn cuff was observed in 45 patients. Factors compared between the patients without delamination and those with delamination were as follows: gender and age of the patients, history of trauma, duration of disorder, diabetes, smoking, size and number of rotator cuff tears.Results: The delamination rate of the smoking patients was significantly higher than non-smoking patients. The delamination rate of patients with more than two tendon tears was significantly higher than those with only one tendon tear. The average size of tear with delamination was significantly larger than that of tear without delamination. The other factors were not related to delamination.Conclusions: This study suggests that smoking, size of tear and number of torn cuffs are associated with delamination. The progression of torn cuff, anatomical features and nicotine of smoking affect the causes of delaminated tear of rotator cuff.

Use of 3D printing to create a bespoke repair of a Percutaneous Endoscopic Gastrostomy (PEG) tube in patient unfit for surgical replacement

We report a case of three-dimensional (3D) printing being used to solve a difficult bedside clinical problem and avoidance of substantial risk associated with alternative solutions. A 15-year-old male with...

Effects of tear size and location on predictions of supraspinatus tear propagation

Rotator cuff tears remain a significant clinical problem with a high incidence rate and severe clinical burden. Previous computational models developed to study rotator cuff tears have not modeled tissue damage and tear propagation. The objective of this study was to predict tear propagation for various combinations of tear size and location using an experimentally validated finite element model of supraspinatus tendon. It was hypothesized that larger rotator cuff tears propagate at lower loads than smaller tears, and that posterior tears require higher loads to propagate than anterior tears. Using a previously validated computational model of supraspinatus tendon, tears of size 0.5–1.5 cm were introduced to the tendon geometry in the anterior, middle, and posterior tendon thirds. Cohesive elements were assigned subject-specific failure properties and used to model tissue damage and tear propagation. A displacement of 5 mm was applied to the medial tendon edge to induce tear propagation. Model outputs included critical load required to propagate the tear, and principal stress and maximum principal strain at the anterior and posterior tear tips. For all tear sizes, posterior tears required the highest loads to propagate (247–567 N). Anterior tears generally required the least load to propagate (171–280 N). Stress and strain were larger on the articular side (maximum 33.9% articular strain vs 27.8% bursal strain). Overall, larger tears located in the anterior supraspinatus tendon that interrupt the rotator cable are most at risk for tear propagation, and should be carefully followed by clinicians when considering treatment options.

Passive stiffness in the supraspinatus muscle after double-row and knotless transossous equivalent repair: A cadaveric study

Background Although various techniques for arthroscopic rotator cuff repair have been introduced, optimal technique is still controversial. Biomechanical studies have been performed to assess tendon-bone interface properties. However, few studies have focused on the effect of the rotator cuff muscle after repair. To determine a technique with improved cuff function, in addition to repair strength, other factors such as stiffness changes in the rotator cuff muscle should also be analyzed. The purpose of this study was to investigate passive stiffness in the supraspinatus (SSP) muscle using shear wave elastography (SWE) after double-row (DR) and knotless transosseous equivalent (KL-TOE) techniques. Methods Twelve fresh-frozen cadaveric shoulders with rotator cuff tear (tear size; small [6], medium-large [6]) were used. Passive stiffness of 4 anatomical regions in the SSP muscle was measured based on an established SWE method. Each specimen underwent 2 types of footprint repair (DR and KL-TOE, in a random order) with the arm at 30° abduction. SWE values, obtained with the arm at 0°, 30°, and 90° abduction, were compared in 3 different conditions: preoperative (torn) and postoperative conditions with the 2 techniques. Results In shoulders with medium-large size tears, SSP muscles showed increased stiffness values after rotator cuff repair with both techniques, and this was significantly observed at 0° abduction. In addition, stiffness of the SSP muscle was uniform among 4 regions after KL-TOE repair, whereas, DR repair caused significantly heterogeneous stiffness distribution within the muscle (P > 0.01). SSP muscles with small size tear did not show any significant differences in stiffness values between regions and repair technique. Conclusion KL-TOE technique for the medium-large size tear provided a more uniform stiffness distribution in repaired SSP muscles compared to the DR technique. Imbalanced muscular stiffness might cause limited functional recovery after the cuff repair. In addition to established evidences of biomechanical properties, the alteration of cuff muscle stiffness should be evaluated to determine the optimal technique.

An Unusual Case of Horner Syndrome

SESSION TITLE: Critical Care 2 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Horner's syndrome manifests in varying degrees of ptosis, miosis, and anhidrosis. Etiology can vary from central lesions, intracranial tumors and strokes, to peripheral causes, such as carotid artery dissections, pancoast tumors, blunt trauma or iatrogenic injuries. Tracheobronchial injury secondary to intubation is a rare complication, occurring in 0.005% of intubations1. We report a case of Horner's syndrome in an intubated patient due to a tracheal tear. CASE PRESENTATION: A 34 year old woman presented to the emergency department with dyspnea. She was febrile, tachycardic, tachypnic and became hypotensive requiring intubation and vasopressors with a diagnosis of septic shock due to pneumonia. On volume assist control ventilation with a positive end expiratory pressure of 10 cm H2O, her PaO2 to FiO2 ratio was 135. Chest x-ray showed bilateral alveolar infiltrates consistent with acute respiratory distress syndrome; treatment included lung protective ventilation and paralysis. She was positive for influenza A and her urine antigen was positive for Streptococcus pneumoniae, however, tracheal cultures from the day of admission grew only Staphylococcus aureus. She received appropriate antibiotics and oseltamivir. On hospital day 9, she was found to have a pneumothorax and a chest tube was placed. That evening, new onset, unilateral right pupil dilation prompted a CT scan of both the head and neck. The CT revealed a linear laceration of the trachea and air extending into the posterior mediastinum (Figures 1 and 2) and superiorly along the carotids. Bronchoscopy revealed a small anterior tracheal tear. The endotracheal tube was advanced beyond the tear and ventilator settings were changed to minimize ventilator pressures. A subsequent bronchoscopy revealed resolution of the tracheal tear. DISCUSSION: We believe that the increased intrathoracic pressure from free air compressed neurons in the sympathetic chain resulting in Horner’s syndrome. Several reported cases demonstrate Horner's syndrome as a complication of pneumomediastinum. Chipman et al, reported an alcoholic patient who presented with right sided ptosis and miosis and was subsequently found to have significant pneumomediastinum stemming from alveolar rupture in the setting of severe retching2. CONCLUSIONS: The development of Horner's syndrome due to tracheal rupture in an intubated patient is a rare finding. In critically ill patients, as here, it may be possible to treat the laceration with conservative, non-procedural management. Reference #1: Management of iatrogenic tracheobronchial injuries: a retrospective analysis of 29 cases. Schneider et al. Ann Thorac Surg. 2007 Jun;83(6):1960-4. Reference #2: Unilateral ptosis and miosis caused by pneumomediastinum Chipman et al. Neurology 2007;68;1155 DISCLOSURE: The following authors have nothing to disclose: Shivdeep Deo, Michael Vest, David Manoff, Michael Sneider, Alberto Iaia, Timothy Roedder No Product/Research Disclosure Information

Superior Capsular Reconstruction With Superimposition of Rotator Cuff Repair for Massive Rotator Cuff Tear

Massive rotator cuff tears are particularly challenging to treat and severely limit the function of the shoulder. Compared with a small rotator cuff tear, massive tears are more unpredictable and usually present with low tendon quality. When performing an anatomical repair of the rotator cuff, the surgical treatment is often associated with failure of the construct. An alternative procedure that can be performed in the setting of a massive tear is superior capsular reconstruction (SCR), using an autograft or allograft. This procedure has been shown to be effective and is associated with positive treatment outcomes. Moreover, the combination of an SCR with an anatomic repair of the rotator cuff tendon may provide a stronger fixation for the rotator cuff and ultimately lead to a lower likelihood of retear and failure. The purpose of this Technical Note is to describe our preferred procedure for the treatment of a massive rotator cuff tear through SCR with superimposition of the repair of the native rotator cuff tendons.

Modified Oblique Sagittal Magnetic Resonance Imaging of Rotator Cuff Tears : Comparison with Standard Oblique Sagittal Images

Rotator cuff disease occurs in adults is very common cause of shoulder pain causes is known as one of the. Combined oblique coronal and oblique sagittal standard magnetic resonance (MR) imaging is highly accurate for detecting full-thickness rotator cuff tears. However, the accuracy of standard MR imaging is lower for partial- thickness tears. Small rotator cuff tears can be obscured by partial volume effect if the imaging planes are not orthogonal to the surface of the cuff. Angling the oblique sagittal images perpendicular to the lateral 2 or 3 cm of the supraspinatus tendon would reduce the partial volume effect, and might make tears in this region more conspicuous. The purpose of our study was to compare the accuracy for diagnosing rotator cuff tears of oblique coronal images supplemented with standard oblique sagittal images versus thinner-section modified oblique sagittal fat suppressed fast spin-echo T2-weighted images. For full-thickness supraspinatus tendon tears, our study confirms that oblique coronal and standard oblique sagittal images are very accurate for diagnosing tears, and that supplementing oblique coronal images with thinner-section angled oblique sagittal images does not improve diagnostic accuracy for those few full-thickness tears that are missed on standard MR images. In conclusion, there was a slight improvement in accuracy for diagnosing rotator cuff tears, particularly partial-thickness tears, for the staff radiologist using the thinner-section angled oblique sagittal images.