scar "in situ"

[Alexander Martinez]

Hi Stephen;
I was wondering if you can diagnose scar “in situ” of the supraspinatus under ultrasound?

[Alexander Martinez]

Hi Stephen:
I am sorry if I did not make myself clear;I meant the tendon itself,either partial delaminating or complete tear of the supraspinatus; With a complete “in Situ”is it possible not to see fluid in the subacromial subdeltoid bursa due to scar or tissue granulation and how can you make the diagnosis under ultrasound<
Thanks again.

[Stephen Bird]

Hi Alexander,
We certainly do see scar tissue (granulation tissue) within the supraspinatus tendon as a result of a partial tear or partial tear with some delimitation component. The key features of such scar tissue is that it is echogenic on ultrasound and often linear in nature. The echogenic tissue will track back to the SST enthesis at the greater tuberosity and at this point there will be a small sub-periosteal cyst present from the traction injury. The echogenic area will not shadow. The echogenic area will be present in both long and short axis planes.
These areas of granulation tissue represent an old tear which has undergone a scar formation process.
It is important not to make a false diagnosis of calcific tendinosis as this is a completely different process of hydroxyapatite deposition which is often very painful.
These scar tissue areas are rarely symptomatic and are rarely associated with either joint or bursa fluid as the injury is some time ago.
They are common.
Steve.

• This reply was modified 6 years ago by Stephen Bird.

[Alexander Martinez]

Hi Stephen:
But in cases of a complete tear with “Scar In Situ” can you see the same ultrasound characteristics and the scar it self act as a seal so you wont see fliud in the subacromial/subdeltoid bursa?

[Stephen Bird]

Hi Alexander,
I have never seen scar tissue act in this way for the supraspinatus tendon,
I certainly see scar tissue form as part of partial thickness tears, especially articular surface (rim rent) and intrasubstance delaminating tears.
But I have not observed large scale scar tissue formation inside full thickness tears.
Full thickness tear defects can be full of peri-bursa fat or haematoma in the acute setting, however this will be seen as a spongy area of soft tissue that will be expelled from the tear site with dynamic assessment.
I have not observed firm scar tissue replacing a tendon in a full thickness SST scenario.

I would be keen to see some images of full thickness SST tear scar in situ.

In my hands I have not seen scar tissue reconstitute the SST to “reseal” the rotator cuff and I have not observed reconstitution which prevents the flow of fluid from joint to bursa space following a full thickness tear.

None of this means it does not happen!

Just means I have not seen it.

I am very keen to see some images.

Steve

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