The Use of Magnetic Resonance Arthrography to Detect Partial-Thickness Rotator Cuff Tears

Abstract

P artial-thickness rotator cuff tears can be caused by trauma or anatomic impingement, or they can be a natural consequence of aging. They may involve either the articular surface, the bursal surface, or both sides of the rotator cuff. They can be asymptomatic or a potential source of shoulder dysfunction. Recent studies have seemed to indicate that partial-thickness cuff tears can progress and do not heal on their own1. The articular side of the rotator cuff is hypovascular (Fig. 1), and the collagen bundles on the articular side are thinner and less uniform (Fig. 2), making articular-sided partial-thickness rotator cuff tears two to three times more common than bursal-sided tears2-8. Magnetic resonance imaging, although a useful and established technique for detecting full-thickness rotator cuff tears, has been found to be less reliable in detecting partial-thickness tears. With the use of standard magnetic resonance imaging techniques, many partial-thickness rotator cuff tears are missed9-12. In 1992, Traughber and Goodwin reported a sensitivity ranging from 56% to 72% and a specificity ranging from 83% to 85% for arthroscopically proven partial-thickness rotator cuff tears9. However, in another study, an 83% rate of false-negative results was reported for arthroscopically proven partial-thickness tears10. Wright and Cofield found only six definite partial-thickness tears on preoperative magnetic resonance imaging studies in eighteen patients with arthroscopically proven partial-thickness tears11. Fig. 1 Coronal photomicrograph of the zone of diminished vascularity of the supraspinatus tendon. The arrow points to the critical zone of hypovascularity of the articular side of the tendon. Magnetic resonance arthrography may improve the sensitivity in the detection of partial-thickness rotator cuff tears. Two years ago, we began a prospective study to detect partial-thickness articular-sided rotator cuff tears using an intra-articular injection of gadolinium …