The Differences of the Acromiohumeral Interval Between Supine and Upright Radiographs of the Shoulder

Abstract Background: Acromiohumeral interval (AHI) is a measurement method to determine the superior migration of the humeral head in patients with rotator cuff tears.Hypothesis/Purpose: The purpose of this study was to compare the AHI measurement in supine shoulder and upright shoulder radiographs, as well as magnetic resonance imaging (MRI), as well as to report the sensitivity, specificity, and accuracy in detecting full thickness rotator cuff tears.Study Design: Diagnostic study.Methods: From July 2020 to May 2021, evaluation of 86 shoulder radiographs in both supine & upright Grashey views compared with the MRI of the affected shoulder. Measurements of the AHI obtained from both radiographs and MRIs was determined by two independent orthopaedic surgeons. The intraclass correlation of the AHI measurement was tested. The difference between the AHI in each view was determined.Result: The 86 shoulders were divided into 3 groups that included; 1) non-full thickness tear (50%), 2) full thickness (FT) tear 3 cm (33.7%), and 3) FT tear > 3 cm (16.3%). The mean difference of AHI noted was significantly lower in the supine radiographs than with the upright (1.34-1.37 mm.). The mean difference of the AHI was significantly lower in the MRI than the upright (1.62-1.87 mm.). AHI obtained from the supine radiographs and MRI had no significant differences. The area under the curve (AUC) of the upright and supine AHI in the diagnosis of the FT tears were at 0.649 and 0.642 accuracy. Upright AHI 7.09 mm. had 27.9% sensitivity and 100% specificity in diagnosing FT tears with 64% accuracy (p<0.001). The upright AHI cut off value of 9.52 mm. had 60.5% sensitivity, 67.4% specificity, and 64% accuracy (p=0.01). The supine AHI 6.56 mm. had 32.6% sensitivity, 100.0% specificity, and 66.3% accuracy (p<0.01). Supine AHI cut off value of 7.42 mm. had 41.9% sensitivity, 86.0% specificity, and 64.0% accuracy (p=0.004). The inter- and intra-rater reliability of AHI measurement in 3 views were of substantial to almost perfect agreement (0.668-0.824).Conclusion: The AHI in supine radiographs were significantly lower than upright shoulder radiographs in all groups as divided by severity of the rotator cuff tear and was comparable with the MRI. For AHI ≤ 7 mm. in upright shoulder radiographs remains as a good diagnostic test of full thickness rotator cuff tears, while this value was not relevant for use as the cut point in the supine radiographs and MRI shoulders.Level of evidence: Level III; Diagnostic studyClinical Relevance: The AHI measurement in supine and upright radiographs are reliable and reproducible. The AHI ≤ 7 mm. in upright shoulder radiographs remains as a good diagnostic test of full thickness rotator cuff tears, while this value was not relevant for use as the cut point in the supine radiographs and MRI shoulders.

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Shoulder-specific outcomes 1 year after nontraumatic full-thickness rotator cuff repair: a systematic literature review and meta-analysis

Shoulder & Elbow ◽

10.1177/1758573217711903 ◽

2017 ◽

Vol 9 (4) ◽

pp. 247-257 ◽

Cited By ~ 7

Author(s):

Navin Gurnani ◽

Derek F. P. van Deurzen ◽

Michel P. J. van den Bekerom

Keyword(s):

Los Angeles ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Constant Score ◽

Meta Analysis ◽

Rotator Cuff Tears ◽

Full Thickness ◽

The Mean ◽

Cuff Repair ◽

Mini Open

Background Nontraumatic full-thickness rotator cuff tears are commonly initially treated conservatively. If conservative treatment fails, rotator cuff repair is a viable subsequent option. The objective of the present meta-analysis is to evaluate the shoulder-specific outcomes one year after arthroscopic or mini-open rotator cuff repair of nontraumatic rotator cuff tears. Methods A literature search was conducted in PubMed and EMBASE within the period January 2000 to January 2017. All studies measuring the clinical outcome at 12 months after nontraumatic rotator cuff repair of full-thickness rotator cuff tears were listed. Results We included 16 randomized controlled trials that met our inclusion criteria with a total of 1.221 shoulders. At 12 months after rotator cuff repair, the mean Constant score had increased 29.5 points; the mean American Shoulder and Elbow Score score increased by 38.6 points; mean Simple Shoulder Test score was 5.6 points; mean University of California Los Angeles score improved by 13.0 points; and finally, mean Visual Analogue Scale score decreased by 4.1 points. Conclusions Based on this meta-analysis, significant improvements in the shoulder-specific indices are observed 12 months after nontraumatic arthroscopic or mini-open rotator cuff repair.

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Risk Factors for Tear Progression in Symptomatic Rotator Cuff Tears: A Prospective Study of 174 Shoulders

The American Journal of Sports Medicine ◽

10.1177/0363546517709780 ◽

2017 ◽

Vol 45 (11) ◽

pp. 2524-2531 ◽

Cited By ~ 23

Author(s):

Nobuyuki Yamamoto ◽

Mitsuyoshi Mineta ◽

Jun Kawakami ◽

Hirotaka Sano ◽

Eiji Itoi

Keyword(s):

Risk Factors ◽

Rotator Cuff ◽

Alcohol Drinking ◽

Sports Participation ◽

Rotator Cuff Tears ◽

Hand Dominance ◽

Full Thickness ◽

Partial Thickness ◽

The Mean ◽

Tear Size

Background: The risk factors for tear progression in symptomatic rotator cuff tears have not been clarified yet. It is important for orthopaedic surgeons to know the natural course of tear progression when nonoperative management is to be chosen. Hypothesis: Tears in younger patients, high-activity patients, or heavy laborers would progress in size more than those in older patients, low-activity patients, or light laborers. Study Design: Case-control study; Level of evidence, 3. Methods: Two hundred twenty-five consecutive patients with symptomatic rotator cuff tears visited our institute between 2009 and 2015. Of these, 174 shoulders of 171 patients (mean age, 66.9 years) who underwent at least 2 magnetic resonance imaging (MRI) examinations were prospectively enrolled. The mean follow-up was 19 months. Tear progression was defined as positive when the tear size increased by ≥2 mm. The demographic factors that were analyzed by multivariate analysis included age, sex, hand dominance, smoking, alcohol drinking, hypercholesterolemia, sports participation, job type, tear size, and tear type (full or partial thickness). Results: Of the 174 shoulders, 82 shoulders (47%) showed tear progression. The mean (±SD) tear length and width in the progression group on final MRI were 23.1 ± 12.5 mm and 17.3 ± 9.6 mm, respectively; the tear size progressed by a mean 5.8 ± 5.6 mm in length and 3.1 ± 5.2 mm in width. The mean propagation speed was 3.8 mm/y in length and 2.0 mm/y in width. The size of full-thickness tears significantly increased compared with that of articular-sided partial-thickness tears ( P = .0215). The size of medium tears significantly increased compared with that of other tears ( P < .0001). According to the logistic regression analysis, smoking was significantly correlated with tear progression ( P = .026). Subgroup analyses showed that male sex, hand dominance, and trauma were correlated with tear progression. Age, alcohol drinking, hypercholesterolemia, sports participation, and job type did not show any correlation with tear progression. Conclusion: The tear size of symptomatic rotator cuff tears progressed in 47% of the shoulders during a mean of 19 months, and the speed of progression was 3.8 mm/y in length and 2.0 mm/y in width. The risk factors for tear progression were (1) a medium-sized tear, (2) a full-thickness tear, and (3) smoking.

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Full-Thickness Rotator Cuff Tears in the Throwing Athlete

Operative Techniques in Sports Medicine ◽

10.1016/j.otsm.2021.150800 ◽

2021 ◽

pp. 150800

Author(s):

Robert A Jack ◽

Michael C Ciccotti ◽

Steven B Cohen ◽

Michael G Ciccotti

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Throwing Athlete

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Can ultrasound suffice for triaging patients requiring surgical correction of rotator cuff tears—a comparative evaluation of ultrasound and magnetic resonance imaging

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00477-2 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Aniket Agarwal ◽

Kavita Vani ◽

Anurag Batta ◽

Kavita Verma ◽

Shishir Chumber

Keyword(s):

Rotator Cuff ◽

Biceps Tendon ◽

Surgical Correction ◽

Statistical Testing ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Partial Thickness ◽

Linear Probe ◽

Significant Difference ◽

Sensitivity Specificity

Abstract Background Objectives: To comparatively evaluate the role of ultrasound and MRI in rotator cuff and biceps tendon pathologies and to establish ultrasound as a consistently reproducible, quick and accurate primary investigation modality sufficient to triage patients requiring surgical correction of full thickness rotator cuff tears. Methods: Fifty patients, clinically suspected to have rotator cuff and/or biceps tendon pathologies, with no contraindications to MRI, were evaluated by US and MRI, in a prospective cross-sectional observational study. US was done with high-frequency linear probe, and MRI was done on a 1.5-T scanner using T1 oblique sagittal, proton density (PD)/T2 fat-suppressed (FS) oblique sagittal, T1 axial, PD/T2 FS axial, T1 oblique coronal, T2 oblique coronal and PD FS oblique coronal sequences. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. The sensitivity, specificity, PPV, NPV and accuracy were also calculated to analyze the diagnostic accuracy of US findings correlating with MRI findings. A p value less than 0.05 was taken to indicate a significant difference. Results Mean age was 45 years; 74% patients were males; 77% females and 60% males had tears. Majority of patients with rotator cuff tears were in the sixth decade of life. The frequency of tears was higher among older patients. Fourteen percent of patients had full thickness tears while 64% had partial thickness tears. US was comparable to MRI for detection of full thickness tears with overall sensitivity, specificity, PPV and accuracy of 93.8%, 100%, 100% and 98.2%, respectively (p value < 0.001). For partial thickness tears, US had overall sensitivity, specificity, PPV and accuracy of 75.6%, 82.6%, 89.5% and 78%, respectively (p value < 0.001), as compared to MRI. Subacromial-subdeltoid bursal effusion and long head of biceps tendon sheath effusion were common associated, though, non-specific findings. Conclusion Ultrasound findings in our study were found to be in significant correlation with findings on MRI in detection of rotator cuff tears. US was equivalent to MRI in detection of full thickness tears and fairly accurate for partial thickness tears. Therefore, US should be considered as the first line of investigation for rotator cuff pathologies.

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