Spoon Lesion; Supraspinatus Tendon Fibrosis and Redundancy with Superior Shoulder Instability

Author(s): Basim A.N. Fleega, Moataz Eldeeb

Purpose: Functional impingement occurs due to muscle imbalance or rotator cuff disease (loss of the force couples around the shoulder) with or without glenohumeral instability that leads to upward migration of the humeral head and narrowing of the subacromial space. In this study, a new supraspinatus dysfunction (Spoon lesion) causing superior instability and secondary impingement as described by the first Author will be presented as well as its arthroscopic diagnostic method (spoon test) and treatment.

Methods: Both clinical, radiological and arthroscopic assessment were done to 55 cases of Spoon lesion, as described above who were treated with arthroscopic resection and tendon reefing in two centers by the same surgeon, between August 2012 and January 2022. 48 cases of primary Spoon lesion and 7 cases of secondary spoon pathology,; 5 of them were cases of Spoon following anterior instability and 2 following Antro-inferior instability, were operated. Arthroscopic resection of the supraspinatus insertion and lateral transosseous suture tension reefing refixation using the Giant needle technique was done to all cases. The seven secondary cases also had an arthroscopic anterior cruciate anterior inferior capsular shift. All patients had a three phases rehabilitation program over a period of 10 weeks to four months.

Results: 48 out of 55 were re-examined with an average follow-up of eight years and 3 months (between 24 months and 12 years). The Neer score was used to evaluate the patients. 43 cases out of the 48 with isolated Spoon lesion achieved an improvement in the score from preoperative unsatisfactory to excellent in 42 (97%) cases and satisfactory in one. The 5 cases of Spoon lesion with instability were all rated excellent.

Conclusions: This study showed the explanation of many cases of impingement like symptoms of the shoulder not responding to treatment although there is no subacromial narrowing nor partial tear. The radiological evaluation, the arthroscopic findings and the histological evaluation are clear signs of a Spoon lesion. Level of evidence IV.