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Letters to the Editor to:

Scientific Articles:
Ganesh Kamath, Leesa M. Galatz, Jay D. Keener, Sharlene Teefey, William Middleton, and Ken Yamaguchi
Tendon Integrity and Functional Outcome After Arthroscopic Repair of High-Grade Partial-Thickness Supraspinatus Tears
J Bone Joint Surg Am 2009; 91: 1055-1062 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read Letter to the Editor] Dr. Galatz and colleagues respond to Dr. Bernstein
Leesa M. Galatz, MD, Jay Keener, MD; Ken Yamaguchi, MD   (10 June 2009)
[Read Letter to the Editor] Association of Partial Thickness Tears of the Rotator Cuff and Shoulder Pain
Joseph Bernstein   (10 June 2009)

Dr. Galatz and colleagues respond to Dr. Bernstein 10 June 2009
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Leesa M. Galatz, MD,
Associate Professor, Shoulder and Elbow Service
Washington Universtiy in St. Louis School of Medicine,
Jay Keener, MD; Ken Yamaguchi, MD

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Re: Dr. Galatz and colleagues respond to Dr. Bernstein

galatzl{at}wudosis.wustl.edu Leesa M. Galatz, MD, et al.

We agree with Dr. Bernstein’s statement that not all partial thickness rotator cuff tears are painful. It should be emphasized that our article applies to partial thickness rotator cuff tears in patients who have failed non-operative treatment, and thus came to surgery. The results and recommendations from our study are specific to symptomatic tears and should not be generalized to asymptomatic ones or those that respond to conservative treatment. As noted by Dr. Bernstein, it is widely accepted that many individuals have asymptomatic partial thickness rotator cuff tears and/or tendinosis which may be evident on MRI. The natural history and potential for full-thickness progression of these tears is unknown. We agree with Dr. Bernstein’s concerns given that we are currently studying the natural history of asymptomatic partial thickness tears as part of our ongoing NIH R01 investigation. We appreciate Dr. Bernstein’s comments and reiterate that our results do not apply for partial rotator cuff tears that can be treated non-operatively.

Association of Partial Thickness Tears of the Rotator Cuff and Shoulder Pain 10 June 2009
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Joseph Bernstein,
Physician
University of Pennsylvania, Philadelphia, Pennsylvania

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Re: Association of Partial Thickness Tears of the Rotator Cuff and Shoulder Pain

orthodoc{at}uphs.upenn.edu Joseph Bernstein

To the Editor:

The opening sentence of the paper, “Tendon Integrity and Functional Outcome After Arthroscopic Repair of High-Grade Partial-Thickness Supraspinatus Tears” by Kamath et al. (1) is extremely troubling. The authors assert, without citation, that, “Partial-thickness tears of the rotator cuff are a common source of shoulder pain”.

Forgetting for a moment whether designating the condition of tendinosis as a, “partial tear”, and thereby implying that this lesion is one in need of “repair”, it is the case that partial-thickness tears of the rotator cuff are also found in asymptomatic individuals. At best then, we can say that, “partial-thickness tears of the rotator cuff are associated with shoulder pain”. I believe that the relationship of partial-thickness rotator cuff tears and shoulder pain must be deemed incidental, not causal.

The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.

Reference

1. Kamath G, Galatz LM, Keener JD, Teefey S, Middleton W, Yamaguchi K. Tendon integrity and functional outcome after arthroscopic repair of high-grade partial-thickness supraspinatus tears. J Bone Joint Surg Am. 2009;91:1055-62.