Supraspinatus Outlet View Research Articles

Interrater and intrarater reliability of four different classification methods for evaluating acromial morphology on standardized radiographs

Acromial morphology is an important pathophysiological factor for the development of subacromial impingement syndrome. There are 3 radiological methods to evaluate acromial morphology: Bigliani, modified Epstein, and acromial angle. However, their reliability have not been compared in a single study, nor using standardized radiographs. Consequently, the evaluation of acromial morphology is currently not validated though its widespread use across the world. The objective of this study was to investigate reliability of the 3 known classifications and the novel Copenhagen Acromial Curve classification. Three experienced clinicians rated 102 standardized supraspinatus outlet view radiographs with the 4 classification methods in 2 separate sessions a month apart. All measurements were blinded. With an expected kappa () and intraclass correlation coefficient (ICC) > 0.7 (+/-0.15), the target sample size was 87 radiographs. The Bigliani classification had interrater and intrarater reliability ranging from fair to good (κ 0.32-0.41 and 0.26-0.62). The modified Epstein classification had fair to good interrater and intrarater reliability (κ 0.24-0.69 and 0.57-0.63). The acromial angle classification had moderate to good interrater and intrarater reliability (κ 0.53-0.60 and 0.59-0.72). The novel Copenhagen Acromial Curve classification showed moderate to good interrater and intrarater reliability (ICC 0.66-0.71 and 0.75-0.78, respectively). The Copenhagen Acromial Curve was the only classification method with an ICC value>0.7. The popular Bigliani classification had the worst reliability. The Copenhagen Acromial Curve classification produces numerical data, as opposed to the other 3 classification methods. This could potentially be utilized in future research to establishing cut-off values for treatment stratification.

Clinical application of acromion radiological classification in diagnosis and treatment of rotator cuff injury

To develop a new classification of acromion based on the subacromial impingement theory and the Rockwood tilt view. And explore the application value of the new classification in the diagnosis and treatment of rotator cuff tear. The clinical data of 101 patients underwent shoulder arthroscopic surgery for impingement syndrome or rotator cuff tear from January to December 2017 were retrospectively analyzed. There were 34 males and 67 females, aged from 34 to 76 years with an average of (56.31±9.63) years old, course of disease from 2 to 12 months with average of 6 months. Preoperative radiographs of the routine anteroposterior view, Rockwood tilt view and the supraspinatus outlet view were obtained. Based on the subacromial impingement theory and Rockwood radiographs, the morphology of the acromion can be divided into three types:typeⅠ(flat type), typeⅡ(bump type), and type Ⅲ (impingement type). Two observers classified 101 shoulder Rockwood radiographs according to the new classification method and the supraspinatus Outlet radiographs according to the traditional acromial morphological classification method. Supraspinatus tendon injuries were classified into no tear, partial-thickness tear, and full-thickness tear according to the arthroscopic findings. Concordance test (Kappa value) between the inter-observer and intra-observer was carried out for the new classification method and the traditional classification method respectively. The rank sum test was used to compare the mean acromiohumeral distance(AHD) of the three acromion forms in the new acromion classification method. Spearman rank correlation test and Gamma method were used to analyze the correlation between the new acromion classification method and the degree of supraspinatus tendon tear. The inter-observer consistency analysis of the new classification system was significantly better than that of the traditional classification (0.827 vs 0.278), the intra-observer consistency analysis of the new classification system were also significantly better than that of the traditional classification (0.921 vs 0.448, 0.890 vs 0.539). There was no statistical significance in the AHD among three types of the new classification(H=2.186, P>0.05). In all 101 patients, the highest proportion of impingement type acromion was 45.5% (46 cases), followed by bump type acromion was 36.6% (37 cases), and flat type acromion was 17.8% (18 cases). The incidence of supraspinatus tendon tear in the patients with impingement type acromion was significantly higher than that of the other two types of acromion, there was a spearman rank correlation between the new acromion type and the degree of the supraspinatus tendon tear(rs=0.719, P<0.001). Rockwood radiographs of the shoulder can well display the anterolateral osteophytes of the acromion. The new acromion classification method based on Rockwood radiographs has high reliability and good reproducibility, in which impingement type of acromion is closely related to supraspinatus tendon tear. Compared with the traditional classification and AHD, the new classification method has more diagnostic value than for rotator cuff injury.

A novel method for determining the X-ray beam angulation of the supraspinatus outlet view.

Rapid and accurate quantification of the supraspinatus outlet view (SOV) is a clinical challenge. To quantify the X-ray beam angle of the SOV using the horizontal angle of the subscapular spine line (SSSL) and to further verify the feasibility of this method. A total of 119 patients who underwent shoulder computed tomography (CT) examination were enrolled in the retrospective study. Three-dimensional (3D) CT reconstruction was performed and manually adjusted to provide the position similar to SOV. The rotation angle of the 3D image along the long axis of the human body (marked as β) was obtained. The horizontal angle of SSSL (marked as α) was measured on the anteroposterior localizer image of shoulder CT. Pearson correlation and linear regression correlation analysis were performed. In addition, the first-time success rate between the experience-based group and the measurement-based group were compared to verify the novel method. We found a linear correlation between α and β (r = 0.962; P = 0.000). There was no significant correlation between the experience-based group and the measurement-based group in terms of age (P = 0.500), sex (P = 0.397), and side (P = 0.710), but there was a significant statistical difference in the first success rate between the two validation groups (χ2 = 5.808a, P = 0.016). This novel quantitative measurement method for determining the X-ray beam angle of SOV using the horizontal angle of SSSL is feasible.

Acromial type in Brazilian young adults

Introduction: Acromion curved and hooked play a key role in shoulder impingement syndrome. Little is known about the acromial type in Brazilian population. Aim: To describe the acromial type profile in Brazilian young adults; to evaluate its correlation to gender and handedness and the occurrence of symmetry between genders. Methodology: Forty acromions of 20 Brazilian adults, both genders, between 21-25 years old were studied. The acromion type was classified by Bigliani/Epstein method by supraspinatus outlet view radiographs. Results: As there was no gender difference in the occurrence of acromial type, we considered male and female groups together. Thus, of the 20 right acromions, we found 5 (25%) type I, 8 (40%) type II and 7 (35%) type III. Of the 20 left acromions, we found 4 (20%) type I, 11 (55%) type II and 5 (25%) type III. The only left-handed volunteer (100%) presented for the right and left shoulder acromial type III. Of the 19 right-handed volunteers, 5 (26.3%) presented right acromion type I, 8 (42.1%) type II, and 6 (31.6%) type III; for the left acromion, 4 (21.1%) presented type I, 11 (57.9%) type II, and 4 (21.1%) type III. Acromial symmetry occurred in female (60%) and male (70%) groups. Conclusion: Type II acromion was the most predominant for right and left shoulder in Brazilian young adults. There was no correlation between acromial type and gender. It was not possible to analyze the correlation between acromial type and handedness. Acromial type tends to be symmetric in our sample.

Evaluation of acromial spur using ultrasonography.

BackgroundThe presence of an acromial spur implies a rotator cuff disorder due to impingement between the acromial spur and the rotator cuff. The purpose of the study was to observe acromial spurs using ultrasonography and to compare measurements between plain radiographs and sonograms.MethodsWe retrospectively enrolled 51 consecutive patients with acromial spurs, which were interpreted on preoperative plain radiographs (supraspinatus outlet view and 30° caudal tilt) and preoperative sonograms. The ultrasonography transducer was held vertically and continuously moved laterally, which corresponded to the long axis of the long head of the biceps. The distance from the most distal margin of the original acromion to the most projected point of the acromial spur was measured.ResultsNo significant difference was found between the plain radiograph and ultrasonography measurements (p=0.186). A moderate to strong correlation was detected between the ultrasonography and supraspinatus outlet-view measurements (r=0.776, p=0.000).Conclusions Anteriorly projected acromial spurs were well-visualized by ultrasonography. No discrepancy in acromial spur length was detected between the use of plain radiography (supraspinatus outlet view and 30° caudal-tilt view) and ultrasonography. The correlation coefficients between the plain radiography and ultrasonography measurements exceeded 0.7.

A Novel Acromion Radiological Classification and Its Clinical Application Study: Comparing Rockwood Tilt View with Arthroscopic Findings in 101 Shoulders

Background: It is estimated that more than 25% of general population more than 60 years old experience rotator cuff tear, acromial impingement syndrome is one of the most common causes. Morphology of acromion is an important extrinsic factor in the development of rotator cuff tear. The traditional classification of the acromion by Bigliani et al. based on supraspinatus outlet view has been widely used, but due to the high requirements for patients to obtain true supraspinatus outlet view and the poor inter-observer reliability, it brings lots of limitations to the clinical use of this classification. In our clinical work, we have noticed that the formation of acromial anterolateral spur on Rockwood tilt view has some relationship to a rotator cuff tear. Objectives: To develop a new classification of acromion based on the subacromial impingement theory and the Rockwood tilt view. And explore the application value of the new classification in the diagnosis and treatment of rotator cuff tear. Methods: From January 2017 to December 2017, 101 cases of shoulder arthroscopic surgeries for impingement syndrome or rotator cuff tear were retrospectively analyzed. We developed a new classification of the acromion based on the Rockwood tilt view as type I flat acromion, type II bump acromion and type III impingement acromion. The status of the supraspinatus tendon was also recorded as no tear, partial-thickness tear, and full-thickness tear. We tested the inter-observer and intra-observer reliability of the new classification system (Kappa value) and analyzed the correlation between the acromion morphology and the rupture of the supraspinatus tendon. Results: In all 101 cases, the most common type was the impingement acromion with 46 patients (45.5%), followed by bump acromion in 37 patients (36.6%), and the flat acromion in 18 patients (17.8%). The inter-observer reliability of the new classification system was significantly better than that of the traditional classification (0.826 vs. 0.281). The incidence of supraspinatus tendon tear in the patients with impingement acromion was significantly higher than that of the other two types of acromion (ϰ2 = 50.316,P &lt; 0.05). Conclusion: The Rockwood tilt view can well demonstrate the exact architecture of the anterolateral acromion spur. The new classification based on Rockwood tilt view has high reliability and good reproducibility. The type III impingement acromion correlates highly with the supraspinatus tendon tear. Level of evidence: Level II.

The acromion in supraspinatus outlet and Rockwood caudal tilt views from three-dimensional computed tomography scan of the shoulder

BackgroundA hooked acromion on an outlet view and a keeled acromion on Rockwood tilt radiographs are associated with rotator cuff tears. The identification of the acromial morphology may be helpful for acromioplasty planning with regarding the acromial types. MethodsDescriptive Laboratory Study. Three-dimensional computed tomography scans models of 108 shoulders in 91 patients with; (1) Normal shoulders, (2) Shoulders with osteoarthritis, and (3) Irreparable rotator cuff tears; were created and adjusted manually to provide the proper supraspinatus outlet and Rockwood views. The acromial morphology/spurs were analyzed, classified and tested for reliability. ResultsThe intra-observer reliability of supraspinatus outlet view had a weak-to-strong agreement [0.828 (95%CI: 0.716–0.945, p-value<0.001), and 0.475 (95%CI: 0.288–0.672, p-value<0.001 from 2 evaluators]. The inter-rater of the supraspinatus outlet view has a minimal-to-moderate agreement [0.782 (95%CI: 0.662–0.907, p-value<0.001), and 0.344 (95%CI: 0.157–0.539, p-value<0.001) in the first and second readings]. The intra-observer reliability of the Rockwood view has a moderate-to-almost-perfect agreement [0.752 (95%CI: 0.652–0.860, p-value<0.001), and 0.903 (95%CI: 0.833–0.974, p-value<0.001) from 2 evaluators]. The inter-observer reliability of the Rockwood view has a moderate-to-strong agreement [0.854 (95%CI: 0.777–0.936, p-value<0.001), and 0.737 (95%CI: 0.634–0.847, p-value<0.001) in the first and second readings]. ConclusionThe classification of acromion morphology under Three-dimensional computed tomography in the supraspinatus outlet view has poor reliability. The Rockwood caudal tilt view model results in moderate-to-almost-perfect reliability that can be developed to the plain radiographic classification to determine the need for acromioplasty in rotator cuff surgery.

ARTHROSCOPIC ACROMIOPLASTY FOR TREATMENT OF SHOULDER IMPINGEMENT SYNDROME

Background: The technique of arthroscopic subacromial decompression (ASD) is an effective alternative to the open operation. The arthroscopic procedure is technically demanding. Patients and methods: Between January 2016 and February 2018, sixteen male patients, who fulfilled the criteria of the subacromial impingement syndrome, underwent arthroscopy, stability testing under anesthesia and arthroscopic acromioplasty. Pain was the chief complaint of every patient in this study. We used modified UCLA shoulder rating scale for clinical evaluation of the all patients. Pre-operative radiographs included an AP and axillary views added to 30° caudal tilt view or a supraspinatus outlet view were done routinely. MRI of the shoulder was done for all cases. Results: Satisfactory results were achieved in all patients and 6 of them were excellent according to UCLA score. Eight patients had good results and two fair, but no poor results were found in this study up to one year postoperative. Pain relief was the most dramatic benefit but function also improved. The subacromial space of the patients was filled with hypertrophic fibrous bands of bursal stroma, often with fibro-fatty tissue. Hyperemia was often observed. Surface ulcerations were identified on the rotator cuff in 8 cases. Rotator cuff partial tear in 4 cases. Conclusion: In cases of primary impingement, calcific tendinitis, or partial thickness rotator cuff tears the arthroscopic acromioplasty and decompression, is the procedure of choice provided that no shoulder instability. The right indications and skilled hands, the results are better than the results of open acromioplasty, as the patients recover faster with less risk of deltoid muscle complications.

The correlation of supraspinatus outlet view with computed tomography for visualization of the anterior acromial undersurface.

Understanding the real shape of the undersurface of the acromion prior to acromioplasty is indispensable. Today, Supraspinatus outlet view (SSOV) is a standard view used to determine the shape of the anterior acromion. Three types of acromial undersurface were described by Bigliani and Morrison. The purpose of this study was to find out whether the real acromial type can be visualized on X-ray SSOV and compare the shape of the anterior undersurface of the acromion visualized on SSOV, with the shape revealed on 2D CT reconstructions. The SSOV X-rays and CT scans of 30 consecutive patients suffering from rotator cuff dysfunction were retrospectively analyzed. The shape of the acromion visualized on plain X-rays was classified according to Bigliani and Morrison classification system. Two-dimensional CT reconstructions were performed, reproducing the lateral, middle, and medial sections of the acromion. The acromial type that was visualized on each of those reconstructions was separately classified according to the Bigliani and Morrison system. A complete profile of the acromial undersurface was constructed from the integration of acromial types seen on each CT section. The acromial morphology seen on X-rays and CTs was compared. A total of 30 patients comprised the study cohort; mean age was 57 (STD=8.5) years. Three Type I, 22 Type II, and 5 Type III acromions were visualized on the SSOV X-rays. CT reconstructions revealed seven different morphological acromial profiles (I,I,I; I,II,II; I,II,III, etc.), which we divided into 3 groups: (1) Uniform (30%), (2) Internally curved (20%), and (3) Internally hooked (50%). The acromial type visualized on X-ray correlated with the acromial type on at least one CT section in all of the cases. In the case of uniform acromial profile, there is a full correlation between the acromial type visualized on X-rays and the type visualized on CT. In non-uniform profiles, there was an incomplete correlation between the types of the acromion visualized on SSOV and CT. SSOV X-rays correlated with or underestimated, but never overestimated, the acromial morphological type. The curved or hooked portion of the acromial undersurface is not always visualized on the SSOV. On X-rays, the middle and lateral sections are seen more accurate than the medial section. Surgeons should be aware that SSOV X-rays may underestimate the true type of the acromial undersurface.

The morphometric anatomy of the delto-fulcral triangle: A 3D CT-based reconstruction study

This study introduced the new delto-fulcral triangle (DFT), the first anatomical model of its kind. As seen from the orthopaedician's supraspinatus-outlet view, the antero-superior point of the coracoid process along with the lateral- and posterior-most acromial landmarks form the boundaries of the DFT. Since these osseous scapular landmarks accounted for both dynamic and static stabilisers of the glenohumeral joint, knowledge of the anatomical features of the DFT may prove beneficial to the orthopaedic surgeon. This study thus aimed to investigate the morphometry of the new DFT. The bony surfaces of one-hundred and sixty-nine (n=169) normal and pathological (Omarthrosis and Cuff-Tear Arthropathy) shoulders from the hospital's CT scan database were reconstructed (Mimics®: Materialise, Leuven, Belgium). Statistical significance was observed between all three groups for Side 2 (LACPF: distance between most lateral and most posterior points of the acromion) and angles α (angle between sides 1 and 3) and β (angle between sides 1 and 2) of the DFT. It was postulated that although pathological cases present with a smaller lateral acromial distance (LACPF), their lateral acromion landmark is more posteriorly placed from the scapular plane than that of a normal case. As the aspects of the morphometric anatomy of the DFT presented with levels of statistical significance, it may provide a means to evaluate the anatomy of normal and pathological cases. Additionally, the three osseous scapular landmarks that create the DFT are clearly visualised and palpable, therefore they are easily reproducible from both X-ray images and CT scans.

Study of correlation between bigliani's acromion types and shoulder problems

Purpose of the study: Acromion Morphology have been implied to have a major role in shoulder pathology especially caused by affecting subacromial space. Among Acromion Morphology studied includes – Acromion Index, Acromion Types, and Acromion Slope etc. Acromion Types as classified according to Bigliani is a faster way to differentiate Acromion on a plain X-ray. Purpose of the study was to assess the effect of Acromion type on shoulder problems. Material and Methods: 100 Patients of above age 40 coming to orthopaedic OPD for shoulder problems (Impingement or rotator cuff pathology) were examined. Their Acromion type were assessed on the basis of x-ray of shoulder (supraspinatus outlet view). Acromion type was then classified according to Bigliani classification. Results: There were 100 patients in the study – 58 males and 42 females. There were 44 type I, 55 Type II and 01 Type III Acromion types accordingly to Bigliani‘s Classification. Mean age of study group was 56.67 ± 6.57.However in Impingement group patients were younger (55.4 ± 6.53) as compared to rotator cuff group patients (58.84 ± 6.06).There were more females in Type I Acromion group and subsequently number of males outnumbered females in Acromion Type II and Type III. There were 63 patients in Impingement group and 37 in rotator cuff group. Right sided shoulders were affected in 68 patients and 32 patients had their left shoulders affected. 73 affected shoulders were of dominant sides. Conclusion: As Acromion Type changes from Type I to Type III, then symptoms of impingement and rotator cuff pathology start to appear at a younger age. This warrants aggressive approach of management of these shoulder pathology in Acromion type II and type III. Keyword: Acromion Types, Bigliani, Impingement,

단순 방사선 사진에서 견봉 및 상완골 대결절의 퇴행성 변화와 MRI상 회전근 개 파열 정도와의 연관성

Purpose: The purpose of this study is to analyze the correlation between the degree of torn rotator cuff as recorded by MRI and degenerative change of acromion and greater tuberosity of humerus determined by simple radiographs. Materials and Methods: Of the 518 cases included in this study, a group of 234 cases had a chronic rotator cuff tear and a control group of 284 cases had an intact rotator cuff in shoulder MRI. The degree of degenerative changes was classified according to the length of spur and morphological change of acromion and greater tuberosity through the true anteroposterior simple radiograph in supraspinatus outlet view. The degree of tear (partial-thickness or full-thickness tear) and the size of complete rotator cuff tear were analyzed according to the MRI findings of shoulder. The authors also evaluated the correlation between the degree and size of torn rotator cuff and the degenerative change of acromion and greater tuberosity. Results: There were significant differences in the size and extent of torn rotator cuff according to the age, sex and degenerative change of acromion and greater tuberosity of humerus (p Conclusion: More degenerative changes of acromion and greater tuberosity in simple shoulder radiographs showed the increased degree and size of torn rotator cuff. Therefore, if a high degree of degenerative change of the acromion and greater tuberosity on simple radiograph is noted, the possibility of degenerative rotator cuff tear should be considered. In addition, the age and sex could be associative factors for larger size of torn rotator cuff.

Diagnosis of bursal-side partial-thickness rotator cuff tears

To study the clinical features and diagnosis of bursal-side partial-thickness rotator cuff tears. From August 1999 to June 2006, 38 patients with bursal-side partial-thickness rotator cuff tear were evaluated. Twenty-eight men and ten women of average age 45.7 years (range, 18-69 years) with 11 left and 27 right shoulders were studied. According to the Ellman classification, 6 cases were classified as grade I, 7 as II and 25 as III. Physical and X-ray examination, including anteroposterior and supraspinatus outlet views, were performed on both shoulders of all patients. Ultrasonography and MR examination were performed in 27 and 35 patients, respectively. Thirteen patients underwent arthroscopic subacromial decompression and debridement of the rotator cuff. Twenty five patients underwent arthroscopic or mini-open subacromial decompression and rotator cuff repair. All patients had shoulder pain, with 18 cases of night pain. No statistical difference in the incidence of night pain was found between the three groups. Strength of forward flexion and abduction of the affected shoulder was decreased in 25 patients. The Neer impingement sign was found in 35 cases (92.1%), Hawkins impingement sign in 27 (71.1%), tenderness of the greater tuberosity in 34 (89.5%), painful arc in 26 (68.4%), and traction test in 26 (68.4%). The positive rates for ultrasonography and MR were 48.1% and 74.3%, respectively. Long-standing motion pain, impingement sign, painful arc, lock and crepitus in the subacromial space are suggestive of bursal-side tears. MRI is much more accurate than ultrasonography. Fat-suppressed T2-weighted images must be included. Arthroscopy is still the gold standard for making the diagnosis.

Acromial shape in asymptomatic subjects: A study of 305 shoulders in different age groups

It has been reported that acromial morphology and age have an independent association with rotator cuff pathology. In a recent study, we found the acromial angle of patients with stage III impingement syndrome (tear in the rotator cuff, according to the Neer classification of shoulder impingement syndrome) to be significantly greater than the acromial angle of their age-matched healthy controls. To find out if acromial shape also changes, i.e., becomes more curved with age, in shoulders without any rotator cuff problems or previous shoulder surgery. Standard supraspinatus outlet view (SOV) was obtained from both shoulders of healthy persons with no shoulder-related problems or previous shoulder surgery (n = 305; 36 SOVs for subjects aged 21-30 years, 60 for 31-40 years, 67 for 41-50 years, 52 for 51-60 years, 48 for 61-70 years, and 42 for over 71 years of age). Acromial angle, tilt, and the type of the acromion were evaluated. There were no statistically significant differences in the evaluated morphological parameters between the different age groups. Our results suggest that the shape of the acromion does not change with age in individuals who do not have any rotator cuff pathology. According to our results, the changes in acromial morphology seem to be similar in each age group.

Radiological evaluation of acromial characteristic using supraspinatus outlet view in shoulder impingement syndrome

Purpose of this study was to find the association between shoulder impingement syndrome (SIS) and morphological characteristics of acromion&nbsp; (acromial&nbsp; tilt&nbsp; angle,&nbsp; typeof&nbsp; acromion,&nbsp; subacromial osteophyte).Supraspinatus&nbsp; outlet&nbsp; view&nbsp; was&nbsp; performed&nbsp; using&nbsp; fluoroscopy. There&nbsp; were&nbsp; 40&nbsp; SIS&nbsp; patients&nbsp; and&nbsp; 40&nbsp; individuals&nbsp; with&nbsp; no&nbsp; shoulder&nbsp; pain&nbsp; examined&nbsp; and&nbsp; measured&nbsp; for&nbsp; their&nbsp; acromial&nbsp; tilt&nbsp; angle,&nbsp; typeof acromion&nbsp; (according&nbsp; to&nbsp; Bigliani’s&nbsp; classification&nbsp; and&nbsp; Park’s&nbsp; criteria)&nbsp; and&nbsp; forthe&nbsp; presence&nbsp; of&nbsp; subacromial&nbsp; osteophyte.&nbsp; Average acromial tilt angle was 34.1° (SD 7.6) for SIS group and 32.1° (SD 7.7) for control group. Type II acromion was found more frequent in both groups (85% and 95%). The association between SIS and acromial tiltangle or between SIS and type of acromion were statisticallyinsignificant (p=0.241 and p=0.221). Subacromial osteophyte was found in 52.5% of SIS group compare to 12.5% among the control group,&nbsp; and&nbsp; the&nbsp; association&nbsp; with&nbsp; SIS&nbsp; was&nbsp; statistically&nbsp; significant&nbsp; (p=0.0003).Subacromial&nbsp; osteophyte&nbsp; was&nbsp; found&nbsp; to&nbsp; have&nbsp; significant association with SIS. Such association was not found in acromial tilt angle and type of acromion. (Med J Indones 2007; 16:176-80)

Acromial spur: Relationship to aging and morphologic changes in the rotator cuff

This study's objective is to elucidate the relationship between acromial spur formation and rotator cuff pathology or aging. The subjects comprised 1029 shoulders in control, cadaveric, and operative groups. A radiograph in the supraspinatus outlet view was taken in all subjects. The lengths of the incident spurs were measured and classified into 3 sizes (small, <5 mm; medium, <10 mm; and large, > or =10 mm). The rotator cuff was macroscopically classified as normal or as having bursal-side fraying, joint-side tear, intratendinous tear, bursal-side tear, complete tear limited to the supraspinatus tendon, or massive tear. In the control group, the overall incidence of spurs and spur size increased with advancing age (P < .001), but the majority of spurs were small (<5 mm). In the cadaveric group, the overall incidence did not correlate with advancing age (P > .05). However, spur size increased with age in subjects aged 50 years or older (P < .001). The incidence of spurs in rotator cuffs with bursal-side tears was highest and was significantly higher than that in normal cuffs and cuffs with bursal-side fraying and intratendinous tears. We observed 40% of medium spurs and 69% of large spurs in cases with bursal-side tears, complete tears limited to the supraspinatus tendon, and massive tears. In the operative group, the overall incidence correlated to advancing age (P < .001), reaching 80% or more in subjects aged 30 years or older. In addition, the size of spurs was larger than that in the other 2 groups in all age groups with few exceptions (P < .05). Small spurs were associated with advancing age. Morphologic change to the bursal side of the rotator cuff may enhance spur growth. The presence of a small spur has no diagnostic value for rotator cuff tears. Spurs measuring 5 mm or more, however, are of diagnostic value because of their high rate of association with bursal-side tear, complete tears limited to the supraspinatus tendon, or massive tears.

THE DOUBLE-DENSITY SIGN

An os acromiale results from the failure of fusion of the acromial secondary centers of ossification. It is most easily seen radiographically on an axillary lateral view. The purpose of the present study was to describe two simple radiographic findings, the double-density sign on a standard anteroposterior view of the shoulder and a cortical irregularity found on a supraspinatus outlet view, that are highly suggestive of an os acromiale. Anteroposterior, axillary lateral, and supraspinatus outlet radiographs of thirty-four shoulders in thirty adult patients with an os acromiale were reviewed by two independent observers and were compared with those of a control group of thirty-one shoulders in twenty-nine patients without an os acromiale. Statistical analysis was performed with use of a generalized logistic regression model to determine if an os acromiale could be detected on all three radiographic views. A kappa analysis was performed to determine interobserver reliability. In the group with an os acromiale, twenty-eight shoulders had a meso-acromion and six had a pre-acromion. A double-density sign was noted on the anteroposterior radiograph of 82.4% of the shoulders, an os acromiale was noted on the axillary lateral radiograph of 95.6% of the shoulders, and a cortical irregularity was noted on the supraspinatus outlet radiograph of 75.8% of the shoulders. In the control group, a double-density sign was noted on the anteroposterior radiograph of 4.8% of the shoulders, no os acromiale was seen on the axillary lateral radiograph of any of the shoulders, and a cortical irregularity was noted on the supraspinatus outlet radiograph of one shoulder. These differences between the os acromiale and control groups were significant (p < 0.0001). The overall sensitivities of the anteroposterior, axillary, and supraspinatus outlet views for the detection of an os acromiale were 82.4%, 94.1%, and 73.5%, respectively. The overall specificities of the three views were 95.2%, 100%, and 98.4%, respectively. The interobserver reliabilities of the three views were 0.66, 0.88, and 0.7, respectively (p < 0.0001). The double-density sign on a standard anteroposterior radiograph of the shoulder and a cortical irregularity on the supraspinatus outlet view are highly suggestive of an os acromiale. An os acromiale should be suspected in a patient with these radiographic findings. Diagnostic study, Level IV-1 (case-control study). See Instructions to Authors for a complete description of levels of evidence.

만성 견관절 동통을 가진 50세 이상 환자의 단순 방사선 사진 분석

Purpose: To evaluate a usefulness of the simple radiograph in the patients with chronic shoulder pain 50 years and older. Material and method: 1152 patients with chronic shoulder pain and 100 asymptomatic individuals were involved in this study. All patients were 50 years and older. We excluded patients who had a history of fracture or dislocation. Radiographic interpretation was performed on a shoulder AP view, an axillary view and a supraspinatus outlet view. For statistical analysis, a chi-square test was performed. A p value of

Radiographic findings associated with symptomatic rotator cuff tears

This study compared shoulder radiographs of patients with a documented rotator cuff tear with those of asymptomatic age-matched controls. Radiographs of 40 subjects with documented rotator cuff tears were evaluated along with similar films of 84 asymptomatic age-matched controls. Three radiographs were taken of each shoulder: (1) acromioclavicular joint view, (2) anterior-posterior view with 30° of external rotation, and (3) supraspinatus outlet view. Two fellowship-trained radiologists interpreted 14 radiographic areas in a blinded fashion. Inspection of the greater tuberosity showed large positive abnormal ratings for sclerosis, osteophytes, subchondral cysts, and osteolysis. No association was noted between acromial morphology and rotator cuff tears. These results indicate that shoulder radiographs of subjects with a documented rotator cuff tear have greater tuberosity radiographic abnormalities that are not noted in asymptomatic subjects without a rotator cuff tear. No relationship was found between tear length and any of the degenerative conditions. (J Shoulder Elbow Surg 2003;12:122-7)

Supraspinatus outlet view in the diagnosis of stages II and III impingement syndrome.

To compare supraspinatus outlet view (SOV) findings at different stages of the impingement syndrome (IS) with findings in asymptomatic age- and sex-matched controls. Pre-operative SOVs were obtained of 37 shoulders of patients scheduled for unilateral open repair of a full-thickness rotator cuff tear (stage III IS) and 74 shoulders of patients scheduled for open (n=46) or arthroscopic (n=28) acromioplasty for tendinitis (stage II IS). Each view of a patient's shoulder was paired with a control view obtained from an age- and sex-matched person with no shoulder problems (n=111). There were no significant differences in acromial morphology as evaluated on the scale devised by BIGLIANI et al. or in the tilt, slope or length of the acromion between the study groups and their controls. However, hooked acromion seemed to be more common in the patients. The thickness of the anterior part of the acromion at the tendinitis stage and the acromial angle at the tear stage of IS were the only parameters that showed significant differences between patients and controls. Variation of the morphology of the acromion as evaluated on a basis of the SOV is associated with IS, but the association is weak and its value in the diagnosis of IS is therefore only as an adjunctive to other diagnostic modalities.