Conservative Treatment of PASTA (Articular Partial Supraspinatus Tendon Avulsion) in a Patient with High Functional Demand: Case Report with a 6-year Follow-up
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Published:
Dec 26, 2024
Keywords:
Rotator cuff tear, conservative treatment, PASTA lesion, case report
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Abstract
Partial Articular Surface Tendon Avulsion (PASTA) lesions are among the most common types of partial rotator cuff injuries. This case report examines a 30-year-old patient with high functional demands who was diagnosed with a PASTA lesion. The patient presented with pain and dysfunction, as assessed by functional scales. A conservative treatment plan was implemented, including medication and a physiotherapy regimen adapted to the patient’s progress. Clinical follow-up and serial imaging with magnetic resonance imaging (MRI) were performed over a six-year period. The evolution of the lesion showed no progression, and significant functional improvement was documented. A review of the literature and this case’s outcomes underscore the potential for conservative management in treating PASTA lesions. This case highlights the need for further research comparing the effectiveness of conservative and surgical interventions.
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How to Cite
Bonadiman, J. A., Mejía Sabando, I. J., Oliveira Moura, M. D., Faiad Piluski, P. C., Castillo Rodríguez, C. H., & Lech, O. (2024). Conservative Treatment of PASTA (Articular Partial Supraspinatus Tendon Avulsion) in a Patient with High Functional Demand: Case Report with a 6-year Follow-up. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(6), 626-631. https://doi.org/10.15417/issn.1852-7434.2024.89.6.1974
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Section
Case Presentations
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References
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supraspinatus tendon avulsion lesions: A retrospective cohort study with propensity score matching. Orthop J Sports Med 2023;11(11):23259671231212882. https://doi.org/10.1177/23259671231212882
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PMID: 2182260
5. Snyder SJ, Pachelli AF, Del Pizzo W, Friedman MJ, Ferkel RD, Pattee G. Partial thickness rotator cuff tears: Results of arthroscopic treatment. Arthroscopy 1991;7(1):1-7. https://doi.org/10.1016/0749-8063(91)90070-E
6. Manoharan A, Falgout D, Feldman M. Arthroscopic repair of a PASTA of the shoulder using a bursal Split. Arthrosc Tech 2021;10(5):e1403-e1408. https://doi.org/10.1016/j.eats.2021.01.033.
7. Rathbun JB, Macnab I. The microvascular pattern of the rotator cuff. J Bone Joint Surg Br 1970;52(3):540-53.
https://doi.org/10.1302/0301-620X.52B3.540
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9. Yuan T, Yang S, Qian H, Lai C, Jiang H, Meng J, et al. All-inside technique versus in situ transtendon repair for
Ellman III partial articular supraspinatus tendon avulsion. J Shoulder Elbow Surg 2023;32(1):24-32.
https://doi.org/10.1016/j.jse.2022.06.018
10. King GJW, Richards RR, Zuckerman JD, Blasier R, Dillman C, Fried RJ, et al. A standardized method for assessment of elbow function. Research Committee, American Shoulder and Elbow Surgeons. J Shoulder Elbow
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11. Thigpen CA, Shanley E, Momaya AM, et al. Validity and responsiveness of the single alpha-numeric evaluation for shoulder patients. Am J Sports Med 2018;46(14):3480-5. https://doi.org/10.1177/0363546518807924
12. Sher J, Uribe J, Posada A, Murphy B, Zlatkin M. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am 1995;77(1):10-5. https://doi.org/10.2106/00004623-199501000-00002
13. Neer CS, Flatow E, Lech O. Tears of the rotator cuff: Long term results of anterior acromioplasty and repair. Ortop Trans 1988;12(3):735.
14. De Almeida Filho IA, Coelho DA. A cicatrização do manguito rotador. Rev Bras Ortop (Sao Paulo) 2021;56(3):291-8. https://doi.org/10.1055/s-0040-1713764
15. Clark J, Harryman D. Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. J Bone Joint Surg Am 1992;74(5):713-25. https://doi.org/10.2106/00004623-199274050-00010
16. Itoi E, Kido T, Sano A, Urayama M, Sato K. Which is more useful, the “Full can test” or the “Empty can test,” in
detecting the torn supraspinatus tendon? Am J Sports Med 1999;27(1):65-8. https://doi.org/10.1177/03635465990270011901
17. Gartsman GM, Milne JC. Articular surface partial-thickness rotator cuff tears. J Shoulder Elbow Surg 1995;4(6):409-15. https://doi.org/10.1016/S1058-2746(05)80031-X
18. Tennent D, Green G. Partial articular supraspinatus tendon avulsion: Should we repair? A systematic review of the evidence. Shoulder Elbow 2020;12(4):253-64. https://doi.org/10.1177/1758573219864101
19. Yamanaka K, Matsumoto T. The joint side tear of the rotator cuff : A followup study by arthrography. Clin Orthrop Relat Res 1994;304(304):68-73. https://doi.org/10.1097/00003086-199407000-00012
2. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. Prevalence and risk factors of a
rotator cuff tear in the general population. J Shoulder Elbow Surg 2010;19(1):116. https://doi.org/10.1016/j.jse.2009.04.006
3. Ji J, Choi C, You H, Parikh D, Oh S. Effects of arthroscopic atelocollagen insertion in high-grade partial articular
supraspinatus tendon avulsion lesions: A retrospective cohort study with propensity score matching. Orthop J Sports Med 2023;11(11):23259671231212882. https://doi.org/10.1177/23259671231212882
4. Ellman H. Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res 1990;(254):64-74.
PMID: 2182260
5. Snyder SJ, Pachelli AF, Del Pizzo W, Friedman MJ, Ferkel RD, Pattee G. Partial thickness rotator cuff tears: Results of arthroscopic treatment. Arthroscopy 1991;7(1):1-7. https://doi.org/10.1016/0749-8063(91)90070-E
6. Manoharan A, Falgout D, Feldman M. Arthroscopic repair of a PASTA of the shoulder using a bursal Split. Arthrosc Tech 2021;10(5):e1403-e1408. https://doi.org/10.1016/j.eats.2021.01.033.
7. Rathbun JB, Macnab I. The microvascular pattern of the rotator cuff. J Bone Joint Surg Br 1970;52(3):540-53.
https://doi.org/10.1302/0301-620X.52B3.540
8. Ueda Y, Sugaya H, Takahashi N, Matsuki K, Tokai M, Hoshika S, et al. Prevalence and site of rotator cuff lesions in shoulders with recurrent anterior instability in a young population. Orthop J Sports Med 2019;7(6):2325967119849876. https://doi.org/10.1177/2325967119849876
9. Yuan T, Yang S, Qian H, Lai C, Jiang H, Meng J, et al. All-inside technique versus in situ transtendon repair for
Ellman III partial articular supraspinatus tendon avulsion. J Shoulder Elbow Surg 2023;32(1):24-32.
https://doi.org/10.1016/j.jse.2022.06.018
10. King GJW, Richards RR, Zuckerman JD, Blasier R, Dillman C, Fried RJ, et al. A standardized method for assessment of elbow function. Research Committee, American Shoulder and Elbow Surgeons. J Shoulder Elbow
Surg 1999;8(4):351-4. https://doi.org/10.1016/S1058-2746(99)90159-3
11. Thigpen CA, Shanley E, Momaya AM, et al. Validity and responsiveness of the single alpha-numeric evaluation for shoulder patients. Am J Sports Med 2018;46(14):3480-5. https://doi.org/10.1177/0363546518807924
12. Sher J, Uribe J, Posada A, Murphy B, Zlatkin M. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am 1995;77(1):10-5. https://doi.org/10.2106/00004623-199501000-00002
13. Neer CS, Flatow E, Lech O. Tears of the rotator cuff: Long term results of anterior acromioplasty and repair. Ortop Trans 1988;12(3):735.
14. De Almeida Filho IA, Coelho DA. A cicatrização do manguito rotador. Rev Bras Ortop (Sao Paulo) 2021;56(3):291-8. https://doi.org/10.1055/s-0040-1713764
15. Clark J, Harryman D. Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. J Bone Joint Surg Am 1992;74(5):713-25. https://doi.org/10.2106/00004623-199274050-00010
16. Itoi E, Kido T, Sano A, Urayama M, Sato K. Which is more useful, the “Full can test” or the “Empty can test,” in
detecting the torn supraspinatus tendon? Am J Sports Med 1999;27(1):65-8. https://doi.org/10.1177/03635465990270011901
17. Gartsman GM, Milne JC. Articular surface partial-thickness rotator cuff tears. J Shoulder Elbow Surg 1995;4(6):409-15. https://doi.org/10.1016/S1058-2746(05)80031-X
18. Tennent D, Green G. Partial articular supraspinatus tendon avulsion: Should we repair? A systematic review of the evidence. Shoulder Elbow 2020;12(4):253-64. https://doi.org/10.1177/1758573219864101
19. Yamanaka K, Matsumoto T. The joint side tear of the rotator cuff : A followup study by arthrography. Clin Orthrop Relat Res 1994;304(304):68-73. https://doi.org/10.1097/00003086-199407000-00012