Rothman, Clin Orthop Relat Res 1965 - The Vascular Anatomy of the Rotator Cuff

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The Vascular Anatomy of the Rotator Cuff

Rothman, Parke·Clin Orthop Relat Res·1965·285 citations·Anatomic study

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Rothman and Parke injected latex into the arterial systems of 44 human shoulders across all ages and used radiolabeled erythrocytes in rabbits to map both the gross vascular anatomy of the rotator cuff and how tendon vascularity changes with aging. The study asks: where does the blood supply come from, where is it deficient, and does it decline with age?

Key Findings

Six named arteries supply the rotator cuff; suprascapular, anterior, and posterior circumflex humeral are constant (100%), while thoracoacromial (76%), suprahumeral (59%), and subscapular (38%) are variable
A hypovascular zone in the distal supraspinatus tendon just proximal to its insertion was found in 63% of specimens — including fetuses — marking this as the anatomic substrate of the 'critical zone'
A previously unnamed vessel, the suprahumeral artery, was identified arising from the third part of the axillary artery in the majority of specimens
Tendon open vascular bed fell significantly with age in rabbits (0.17 → 0.07, p < 0.005), providing quantitative evidence for age-related tendon ischemia
Tendon-to-muscle vascularity ratio held constant at ~1:3 across age groups, suggesting proportional rather than selective tendon vascular decline

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The Vascular Anatomy of the Rotator Cuff

Rothman, Parke·Clin Orthop Relat Res·1965·285 citations·Anatomic study

|

Rothman and Parke injected latex into the arterial systems of 44 human shoulders across all ages and used radiolabeled erythrocytes in rabbits to map both the gross vascular anatomy of the rotator cuff and how tendon vascularity changes with aging. The study asks: where does the blood supply come from, where is it deficient, and does it decline with age?

Key Findings

Six named arteries supply the rotator cuff; suprascapular, anterior, and posterior circumflex humeral are constant (100%), while thoracoacromial (76%), suprahumeral (59%), and subscapular (38%) are variable
A hypovascular zone in the distal supraspinatus tendon just proximal to its insertion was found in 63% of specimens — including fetuses — marking this as the anatomic substrate of the 'critical zone'
A previously unnamed vessel, the suprahumeral artery, was identified arising from the third part of the axillary artery in the majority of specimens
Tendon open vascular bed fell significantly with age in rabbits (0.17 → 0.07, p < 0.005), providing quantitative evidence for age-related tendon ischemia
Tendon-to-muscle vascularity ratio held constant at ~1:3 across age groups, suggesting proportional rather than selective tendon vascular decline

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