PASTA of the Shoulder

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

• PASTA lesions are usually seen in athletes.
• The tear of the rotator cuff is partial and on the articular surface side.
• There is supraspinatus tendon avulsion and it is difficult to diagnose.
• An arthrogram may help in the diagnosis.
• The tear could be seen on an ultrasound or MRI.
• The MRI arthrogram is done in the ABER position (abduction/external rotation) and is more accurate in showing this lesion.
• The arm will be above the head in the scanner. The normal rotator cuff is about 10-12 mm in thickness.
• If exposed bone between the rotator cuff and the articular margin is more than 7 mm, then there is an at least 50% thickness tear. This is a classic indication for surgery.
• When the lesion is less than 50% and painful, you can debride it. If the lesion is more than 50% and painful, you can repair it.
• The physician may complete the tear to become a full thickness tear, then repair the tear.
• Rotator tears can be full thickness tears or partial thickness tears. PASTA tears may be associated with internal impingement, which is different than external impingement.
• With external impingement, it is subacromial impingement (bursal pathology). In internal impingement, the pathology is on the undersurface of the cuff, so PASTA tears may be associated with internal impingement.