The vascularity of the rotator cuff.

The major arterial supply to the rotator cuff is derived from the ascending branch of the anterior humeral circumflex artery, the acromial branch of the thoracoacromial artery, as well as the suprascapular and posterior humeral circumflex arteries. The pathogenesis of rotator cuff tears has been considered to be influenced by the microvascular supply of the rotator cuff tendons. Most cadaver studies have demonstrated a hypovascular area within the critical zone of the supraspinatus tendon. It has been suggested that this area of hypovascularity has a significant role in the attritional degeneration of the aging tendon. More recent studies of the microvascular supply to the supraspinatus tendon in symptomatic patients with impingement syndrome suggest that in the area of greatest impingement, i.e., the critical zone, there is actually hypervascularity. In contrast to the cadaver investigations, these studies seem to imply that hypervascularity or neovascularization is associated with symptomatic rotator cuff disease secondary to mechanical impingement.