scholarly journals Identifying Key Factors Associated with Subscapularis Tendon Tears and Developing a Risk Prediction Model to Assist Diagnosis

2021 ◽  
Author(s):  
Wennan xu ◽  
Fei wang ◽  
Qingyun xue
Keyword(s):  
Prediction Model ◽  
Risk Estimation ◽  
Biceps Tendon ◽  
Arthroscopic Surgery ◽  
Tendon Injury ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Related Factors ◽  
Tendon Tears ◽  
Magnetic Resonance Imaging Mri

Abstract Background: Subscapularis (SSC) tendon tears can cause pain and restricted motion of the shoulder, but accurate diagnosis of this lesion on magnetic resonance imaging (MRI) is challenging, especially in small and partial tears. There are no studies that have established a method to reliably assess the risk of subscapularis tendon tears.Methods: Data on 460 patients who received shoulder arthroscopic surgery with preoperative shoulder MRI were collected retrospectively. Of these, patients with SSC tendon tears were defined as the SSC tear group, and patients with intact subscapularis tendon were enrolled in the non-SSC tear group. Logistic regression analysis was used to identify the risk factors of SSC tendon tears which were then incorporated into the nomogram. Results: Among 22 candidate factors, five independent factors including coracohumeral distance CHD (oblique sagittal) (OR, 0.75; 95%CI, [0.67-0.84]), fluid accumulation (Y-face) (OR, 2.29; 95%CI, [1.20-4.38]), long head of biceps tendon (LHB) dislocation/subluxation (OR, 3.62; 95%CI, [1.96-6.68]), number of posterosuperior (PS) rotator cuff tears (OR, 5.36; 95%CI, [3.12-9.22]), and MRI diagnosis (OR, 1.88; 95%CI, [1.06-3.32]) were identified as key predictors associated with subscapularis tendon tears. Incorporating these predictors, the nomogram achieved a good C index with a good agreement on the risk estimation of calibration plots. Higher total points of the nomogram were associated with a greater risk of subscapularis tendon tears. Conclusion: The diagnostic accuracy of conventional 3.0-T MRI for SSC tendon tears was insufficient. Our study revealed critical predictors associated with subscapularis tendon tears. When evaluating the severity of subscapularis tendon injury, more attention should be paid to these tear-related factors. We developed and validated s satisfactory prediction model to improve the diagnostic performance of MRI which was convenient for clinicians to reach a consensus on risk assessment and identify the SSC tendon tears.

scholarly journals The Impact of Smoking on Clinical Results Following the Rotator Cuff and Biceps Tendon Complex Arthroscopic Surgery

2021 ◽  
Vol 10 (4) ◽  
pp. 599
Author(s):  
Jan Zabrzyński ◽  
Gazi Huri ◽  
Maciej Gagat ◽  
Łukasz Łapaj ◽  
Alper Yataganbaba ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Functional Outcomes ◽  
Shoulder Arthroscopy ◽  
Smoking Status ◽  
Biceps Tendon ◽  
Arthroscopic Surgery ◽  
Rotator Cuff Tears ◽  
Shoulder Injuries ◽  
The Impact

The purpose of this study was to investigate the association of smoking and functional outcomes after arthroscopic treatment of complex shoulder injuries: rotator cuff tears (RCTs) with biceps tendon (LHBT) tears. This retrospective case-control study has been conducted on a cohort of patients who underwent shoulder arthroscopy between 2015 and 2017 due to complex injury treatment. The outcomes were assessed using the American Shoulder and Elbow Surgeons Score (ASES), the University of California at Los Angeles (UCLA) Shoulder Score, need for non-steroid anti-inflammatory drugs (NSAIDs) consumption and the visual analog scale (VAS). Complications and changes in smoking status were also noted. A cohort of 59 patients underwent shoulder arthroscopy, due to complex LHBT pathology and RCTs, and were enrolled in the final follow-up examination; with mean duration of 26.03 months. According to smoking status, 27 of patients were classified as smokers, and the remaining 32 were non-smokers. In the examined cohort, 36 patients underwent the LHBT tenotomy and 23 tenodesis. We observed a relationship between smoking status and distribution of various RCTs (p < 0.0001). The mean postoperative ASES and UCLA scores were 80.81 and 30.18 in the smoker’s group and 84.06 and 30.93 in the non-smoker’s group, respectively. There were no statistically significant differences in pre/postoperative ASES and postoperative UCLA scores between smokers and non-smokers (p > 0.05). The VAS was significantly lower in the non-smokers’ group (p = 0.0021). Multi-tendon injuries of the shoulder are a serious challenge for surgeons, and to obtain an excellent functional outcome, we need to limit the negative risk factors, including smoking. Furthermore, there is a significant association between smoking and the occurrence of massive rotator cuff tears, and the pain level measured by the VAS. Simultaneous surgical treatment of RC and LHBT lesions in the smoker population allowed us to obtain the functional outcomes approximated to non-smokers in the long-term follow-up. Of course, we cannot assert that smoking is the real cause of all complications, however, we may assume that this is a very important, negative factor in shoulder arthroscopy.

scholarly journals Hidden Long Head of the Biceps Tendon Instability and Concealed Intratendinous Subscapularis Tears

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989812
Author(s):  
Sang Hoon Chae ◽  
Tae Wan Jung ◽  
Sang Hyeon Lee ◽  
Myo Jong Kim ◽  
Seung Min Park ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Predictive Value ◽  
Scoring System ◽  
Biceps Tendon ◽  
Arthroscopic Surgery ◽  
Subscapularis Tendon ◽  
Tendon Tear ◽  
Cutoff Value ◽  
Subscapularis Tendon Tear ◽  
Arthroscopic Findings

Background: Few studies have described the characteristics of a concealed intratendinous subscapularis tear (CIST), and there is a lack of research on the preoperative predictability of such lesions. Purpose: To describe the characteristics of a CIST as seen on magnetic resonance imaging (MRI) and intraoperatively and to develop a scoring system for predicting such lesions. Study Design: Case series; Level of evidence, 4. Methods: Retrospectively, we identified 43 patients with CISTs among 442 consecutive patients who had undergone rotator cuff repair from July 2014 to June 2016. Range of motion, visual analog scale results for pain and function, and patient-reported outcome scores were evaluated preoperatively and at 1 and 2 years postoperatively. CISTs were classified arthroscopically as small (<5 mm), medium (5-10 mm), and large (>10 mm). We performed repair (≥50%) or debridement (<50%) depending on the total subscapularis tendon tear size including the CIST. Preoperative MRI findings were analyzed by 2 observers and were correlated with the arthroscopic findings. A 10-point scoring system was developed based on characteristics during the physical examination (anterior tenderness, bear hug sign), MRI (biceps tendon displacement and subluxation, subscapularis signal change just lateral to the lesser tuberosity), and arthroscopic surgery (medial biceps tendon lesion, combined subscapularis tendon tear), with a cutoff value of ≥7 predicting a CIST. After the retrospective study, we prospectively enrolled 95 patients to validate the 10-point CIST scoring system. Results: All 43 patients diagnosed with a CIST during the retrospective study improved both range of motion and functional scores at 1 year postoperatively. The interrater agreement of the 2 observers was substantial for the evaluation of all parameters except for subscapularis tear classification, which was moderate. On arthroscopic surgery, 11 small, 19 medium, and 13 large CISTs were detected. The preliminary prospective study showed a sensitivity of 61.9%, specificity of 94.3%, positive predictive value of 89.0%, negative predictive value of 75.7%, and accuracy of 80.0% when the cutoff value was set at ≥7 on the CIST scoring system. Conclusion: A CIST can be suspected using a combination of preoperative MRI and intra-articular diagnostic arthroscopic findings, but a definitive diagnosis requires an arthroscopic view. On the 10-point CIST scoring system, a score of ≥5 can be suggestive of a CIST, and a score of ≥7 is most likely to predict a CIST.

scholarly journals Association Between Rotator Cuff Tears and Superior Migration of the Humeral Head: An MRI-Based Anatomic Study

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110098
Author(s):  
Matthew Y. Siow ◽  
Brendon C. Mitchell ◽  
Michael Hachadorian ◽  
Wilbur Wang ◽  
Tracey Bastrom ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Inclusion Criteria ◽  
Rotator Cuff Disease ◽  
Level Of Evidence ◽  
Shoulder Mri ◽  
Magnetic Resonance Imaging Mri ◽  
The Relationship

Background: Superior humeral migration has been established as a component of rotator cuff disease, as it disrupts normal glenohumeral kinematics. Decreased acromiohumeral interval (AHI) as measured on radiographs has been used to indicate rotator cuff tendinopathy. Currently, the data are mixed regarding the specific rotator cuff pathology that contributes the most to humeral head migration. Purpose: To determine the relationship between severity of rotator cuff tears (RCTs) and AHI via a large sample of magnetic resonance imaging (MRI) shoulder examinations. Study Design: Cohort study; Level of evidence, 3. Methods: A search was performed for 3-T shoulder MRI performed in adults for any indication between January 2010 and June 2019 at a single institution. Three orthopaedic surgeons and 1 musculoskeletal radiologist measured AHI on 2 separate occasions for patients who met the inclusion criteria. Rotator cuff pathologies were recorded from imaging reports made by fellowship-trained musculoskeletal radiologists. Results: A total of 257 patients (mean age, 52 years) met the inclusion criteria. Of these, 199 (77%) had at least 1 RCT, involving the supraspinatus in 174 (67.7%), infraspinatus in 119 (46.3%), subscapularis in 80 (31.1%), and teres minor in 3 (0.1%). Full-thickness tears of the supraspinatus, infraspinatus, or subscapularis tendon were associated with significantly decreased AHI (7.1, 5.3, and 6.8 mm, respectively) compared with other tear severities ( P < .001). Having a larger number of RCTs was also associated with decreased AHI (ρ = –0.157; P = .012). Isolated infraspinatus tears had the lowest AHI (7.7 mm), which was significantly lower than isolated supraspinatus tears (8.9 mm; P = .047). Conclusion: Although various types of RCTs have been associated with superior humeral head migration, this study demonstrated a significant correlation between a complete RCT and superior humeral migration. Tears of the infraspinatus tendon seemed to have the greatest effect on maintaining the native position of the humeral head. Further studies are needed to determine whether early repair of these tears can slow the progression of rotator cuff disease.

scholarly journals Diagnostic Accuracy of Ultrasonography for Rotator Cuff Tears: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110351
Author(s):  
Ali S. Farooqi ◽  
Alexander Lee ◽  
David Novikov ◽  
Ann Marie Kelly ◽  
Xinning Li ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Diagnostic Accuracy ◽  
Biceps Tendon ◽  
Meta Analysis ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Partial Thickness ◽  
Diagnostic Values ◽  
Tendon Tears ◽  
Sensitivity Specificity

Background: With recent improvements in transducer strength, image resolution, and operator training, ultrasound (US) provides an excellent alternative imaging modality for the diagnosis of rotator cuff tears. Purpose: To evaluate the diagnostic accuracy of US for partial- and full-thickness rotator cuff tears and biceps tendon tears, compare diagnostic values with those of magnetic resonance imaging (MRI) using arthroscopy as the reference standard, assess longitudinal improvements in accuracy, and compare diagnostic values from operators with different training backgrounds. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed and Cochrane Library databases were systematically searched for full-text journal articles published between January 1, 2010, and April 1, 2020. The inclusion criteria were studies that evaluated the diagnostic accuracy of US for rotator cuff tears or biceps tendon tears utilizing arthroscopy as the reference standard. The exclusion criteria were studies with <10 patients, studies including massive tears without reporting diagnostic data for specific tendons, and studies lacking diagnostic outcome data. Extracted outcomes included diagnostic accuracy, sensitivity, specificity, negative predictive value, and positive predictive value. The mean difference and 95% confidence interval were calculated for both US and MRI diagnostic values, and meta-analysis was conducted using the Mantel-Haenszel random-effects model. Results: In total, 23 eligible studies involving 2054 shoulders were included. US demonstrated a higher median diagnostic accuracy for supraspinatus tendon tears (0.83) and biceps tendon tears (0.93) as compared with subscapularis tendon tears (0.76). US was found to have a higher median accuracy (0.93) for full-thickness supraspinatus tears than partial-thickness tears (0.81). US had superior median sensitivity for partial-thickness supraspinatus tears when performed by radiologists as opposed to surgeons (0.86 vs 0.57). Meta-analysis of the 5 studies comparing US and MRI demonstrated no statistically significant difference in diagnostic sensitivity, specificity, or accuracy for any thickness supraspinatus tears (P = .31-.55), full-thickness tears (P = .63-.97), or partial-thickness tears ( P = .13-.81). Conclusion: For experienced operators, US is a highly sensitive and specific diagnostic modality for the diagnosis of supraspinatus tears and demonstrates statistically equivalent capability to MRI in the diagnosis of both full- and partial-thickness rotator cuff tears.

scholarly journals Imaging Review of Subscapularis Tendon and Rotator Interval Pathology

2022 ◽  
Vol 2022 ◽  
pp. 1-9
Author(s):  
Zohaib Y. Ahmad ◽  
Luis E. Diaz ◽  
Frank W. Roemer ◽  
Ajay Goud ◽  
Ali Guermazi
Keyword(s):  
Rotator Cuff ◽  
Glenohumeral Joint ◽  
Supraspinatus Tendon ◽  
Tendon Injury ◽  
Subscapularis Tendon ◽  
Rotator Interval ◽  
Biceps Pulley ◽  
Magnetic Resonance Imaging Mri ◽  
Tendon Pathology ◽  
Patterns Of Injury

As the largest rotator cuff muscle, the subscapularis plays a major role in stabilizing the glenohumeral joint, in conjunction with surrounding rotator cuff structures. Injury to the subscapularis tendon can be isolated, but more commonly is seen in conjunction with supraspinatus tendon pathology. Injury can be associated with biceps pulley instability, superior labral anterior-posterior (SLAP) tears, humeral head subluxation, and anterosuperior and coracoid impingements. The involvement of the rotator interval can lead to what is called “the hidden lesion,” due to its difficulty to diagnose during arthroscopy. Understanding the anatomical relations of the subscapularis tendon with the rest of the rotator cuff and rotator interval, as well as common patterns of injury that involve the subscapularis tendon, can aid in proper diagnosis of these injuries leading to prompt surgical repair. This review describes the anatomy of the subscapularis muscle and tendon, and the magnetic resonance imaging (MRI) patterns of subscapularis tendon injury.

The Rotator Cuff and Biceps Tendon

2018 ◽  
pp. 131-170
Author(s):  
Joaquin Sanchez-Sotelo
Keyword(s):  
Rotator Cuff ◽  
Biceps Tendon ◽  
Arthroscopic Surgery ◽  
Rotator Cuff Tears ◽  
Rotator Cuff Disease ◽  
Calcifying Tendinitis ◽  
Technological Advances ◽  
Assessment And Treatment ◽  
Long Head ◽  
Muscle Changes

Rotator cuff disease is the most common condition responsible for shoulder pain worldwide. The understanding and treatment of rotator cuff disease has advanced tremendously over the last few years, mostly due to both technological advances (magnetic resonance imaging, ultrasonography, arthroscopic surgery, and reverse arthroplasty) and a better understanding of the biology of healing and of muscle changes over time. Not uncommonly, the long head of the biceps tendon presents structural pathology in patients with cuff disease; however, determining the contribution of biceps pathology to patients’ symptoms is not always straightforward. This chapter discusses these issues and covers aspects of assessment and treatment of rotator cuff disease such as anatomy and function, basic science, rotator cuff tears, calcifying tendinitis, neuropathies and the rotator cuff, and biceps tendon pathology.

scholarly journals MRI overestimates the full-thickness tear of distal triceps tendon rupture

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901877836 ◽  
Author(s):  
Erica Kholinne ◽  
Hassan Al-Ramadhan ◽  
Abdulrahman M Bahkley ◽  
Malak Q Alalwan ◽  
In-Ho Jeon
Keyword(s):  
Tendon Rupture ◽  
Tendon Injury ◽  
Full Thickness ◽  
Triceps Brachii ◽  
Complete Tear ◽  
Partial Tears ◽  
Triceps Tendon Rupture ◽  
Tendon Tears ◽  
Magnetic Resonance Imaging Mri ◽  
Triceps Tendon

Purpose: Injury to the distal triceps brachii tendon is rare. Imaging radiographs are used to confirm the findings of physical examination, classify the extent of injury, and guide treatment. Magnetic resonance imaging (MRI) is considered the gold standard of diagnostic imaging. However, no previous study has reported on the accuracy of differentiation between partial- and full-thickness triceps tendon tears. Our study’s aim was to define the accuracy of MRI in differentiating partial- from full-thickness tear of the distal triceps tendon. We hypothesized that MRI has low accuracy in differentiating partial- from full-thickness tears. Methods: A total of eight patients with nine triceps tendon tears underwent surgical repair from 2011 to 2015. MRI of the elbows were retrospectively reviewed for the presence and type of tear, tendon involvement, and location of the tear, and later correlated with surgical findings. Results: Of the three surgically confirmed complete tears, MRI correctly reported a complete tear in all patients. Of the six partial tears confirmed at surgery, MRI correctly identified four tears. In two cases, MRI described a complete tear, but only a partial tear was noted at surgery. Conclusion: False-positive MRI assessment of distal triceps injury is not rare. Surgeons should rely on clinical examination in assessing distal triceps tendon injury, with imaging studies providing an adjunctive role in the diagnosis and decision-making.

scholarly journals Subscapularis Tendon Tears – Usefulness of Written MRI Reports for Guiding Patient Referral to Shoulder Specialists

2021 ◽  
Author(s):  
Robert Lenz ◽  
Jörn Kircher ◽  
Knut Schwalba ◽  
Marc-André Weber ◽  
Thomas Tischer
Keyword(s):  
Rotator Cuff ◽  
General Practitioners ◽  
Correct Diagnosis ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Mri Findings ◽  
Radiology Reports ◽  
Rotator Cuff Injuries ◽  
Tendon Tears

Introduction Rotator cuff tears are one of the most common reasons for shoulder pain, and patients often present initially to general practitioners. However, subscapularis tears are especially difficult to diagnose and hence adequate therapy is often delayed. General practitioners or non-specialist orthopedic surgeons need reliable MRI findings to allow timely referral of patients to shoulder specialists. The purpose of this study was to determine the validity of the written MRI report of patients with arthroscopically proven subscapularis tendon tears. Method In this retrospective study, 97 patients (mean age 62.4 ± 10 years, 63 men) who underwent arthroscopic subscapularis repair between April 2013 and January 2015 by two experienced shoulder surgeons and who underwent a preoperative 1.5 T MRI study were included. All of these patients had high-field strength (i. e., ≥ 1.5 T) standard MRI scans performed within 4–164 (mean 57.4 ± 38.4) days before their arthroscopic procedures. Results and Conclusion Subscapularis tendon tears, verified by arthroscopy, were correctly identified in only 37 of 97 cases in the written report of the preoperative MRI. This resulted in an overall low sensitivity of 38.1 %. Correctly predicted lesions were as follows: Fox and Romeo I 29.4 % (5/17 patients), Fox and Romeo II 20 % (7/35 patients), Fox and Romeo III 46.7 % (14/30 patients) and Fox and Romeo IV 73.3 % (11/15 patients). In contrast, concurrent supraspinatus tendon tears were identified correctly in 88.2 % of patients (60/68 cases, sensitivity 88.2 %, specificity 96.5 %). Preoperative written radiology reports provided by a heterogeneous group of 39 presumably non-MSK-specialized radiologic centers do not reliably detect subscapularis tendon tears and are not sufficient for guiding patients to specialist centers. Compared to other rotator cuff injuries, this study shows difficulties in the correct diagnosis of subscapular tendon injuries. However, this is necessary to provide patients with timely therapy. It can be assumed that MRI review by musculoskeletal-specialized radiologists would more often than not lead to the correct diagnosis. Key Points:  Citation Format

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