Determination of subacromial space width and inferior acromial mineralization by 3D CT

Abstract

A reduction of the subacromial space and an increased subacromial pressure have been considered to play an important role in the pathogenesis of rotator cuff lesions. The objective of the current study was to develop a CT based method for measuring the acromiohumeral distance and inferior acromial mineralization. In seven patients with unilateral rupture of the rotator cuff and two with impingement syndrome, transverse CT images were obtained at a section thickness of 1 mm with muscular relaxation in a standardized position. The bones were then reconstructed three-dimensionally, and the minimal vertical distance between the acromion and the humerus was determined in three secondary frontal images on both sides. The distribution of mineralization within the inferior surface of the acromion was assessed using CT osteoabsorptiometry. Although the Constant score was significantly reduced in the diseased shoulders, the width of the subacromial space was not routinely lower than on the contralateral side. In seven cases the maximal inferior acromial mineralization was identical in both shoulders, and in two cases it was lower on the affected side. These preliminary data suggest that with muscular relaxation no narrowing of the subacromial space can be detected in secondary frontal CT images, and that a potential increase of subacromial pressure is not high enough to cause a measurable increase in inferior acromial bone density. The method presented makes it possible to investigate the pathogenesis of the supraspinatus outlet syndrome in vivo with greater precision than has so far been possible with conventional radiography.