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Metayer B, Fouasson-Chailloux A, Le Goff B, Darrieutort-Laffite C. A prospective study of 100 patients with rotator cuff tendinopathy showed no correlation between subacromial bursitis and the efficacy of ultrasound-guided corticosteroid injection. Eur Radiol 2024; 34:300-307. [PMID: 37540320 DOI: 10.1007/s00330-023-09989-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/24/2023] [Accepted: 06/07/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES The objective of this study was to determine whether the presence of subacromial bursitis in patients with rotator cuff tendinopathy (RCT) was associated with a better outcome after ultrasound (US)-guided subacromial corticosteroid injection. METHODS A single-center prospective study was performed including patients referred for subacromial injection to manage RCT. At baseline, all patients received an US-guided intra-bursal injection of betamethasone (1 ml). The primary endpoint was reduced pain 3 months (M3) after the procedure: a good responder was defined by a decrease in Visual Analogue Scale pain of more than 30%. Secondary endpoints included functional recovery assessed by the Oxford Shoulder Score (OSS) and clinical success at 6 weeks (W6). We also explored the association between good clinical response and other factors, such as US or X-ray features. RESULTS One hundred patients were included and 49 presented with subacromial bursitis. At M3, 60% of patients (54/100) were considered good responders. The rate of good responders did not differ between the bursitis and non-bursitis groups (p = 0.6). During follow-up, OSS improved over time whether bursitis was present or not. We did not find any US or X-ray features significantly associated with a favorable clinical outcome. CONCLUSION The presence of subacromial bursitis did not influence clinical outcomes at 3 months post-subacromial injection in patients suffering from RCT. CLINICAL RELEVANCE STATEMENT The presence of subacromial bursitis did not influence clinical outcomes at 3 months post-subacromial corticosteroid injection in patients with rotator cuff tendinopathy. For patient management, looking for ultrasonographic signs of bursitis does not appear relevant for the indication of the injection. KEY POINTS • Ultrasound-guided subacromial corticosteroid injections led to a significant improvement in 60% of patients suffering from rotator cuff tendinopathy. • The presence of subacromial bursitis was not associated with better improvement at 3 months post-injection. • Except for the Minnesota score referring to job satisfaction, we did not find any baseline clinical, X-ray, or ultrasound characteristics associated with a successful outcome.
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Affiliation(s)
- Benoit Metayer
- Service de Rhumatologie, CH de Cholet, Cholet, France
- Service de Rhumatologie, CHU Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique Et Réadaptation Locomotrice Et Respiratoire, CHU Nantes, Nantes, France
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000, Nantes, France
| | - Benoit Le Goff
- Service de Rhumatologie, CHU Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000, Nantes, France
| | - Christelle Darrieutort-Laffite
- Service de Rhumatologie, CHU Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France.
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000, Nantes, France.
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Acromial Morphology and Its Relation to the Glenoid Is Associated with Different Partial Rotator Cuff Tear Patterns. J Clin Med 2022; 12:jcm12010233. [PMID: 36615033 PMCID: PMC9821296 DOI: 10.3390/jcm12010233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
The pathogenesis of subacromial impingement syndrome is controversially discussed. Assuming that bursal sided partial tears of the supraspinatus tendons are rather the result of a direct subacromial impact, the question arises whether there is a morphological risk configuration of the acromion and its spatial relation to the glenoid. Patients who underwent arthroscopic repair of either a partial articular supraspinatus tendon avulsion (PASTA) or bursal-sided supraspinatus tear (BURSA) were retrospectively allocated to two groups. Various previously described and new omometric parameters on standard anteroposterior and axial shoulder radiographs were analyzed. We hypothesized that acromial shape and its spatial relation to the glenoid may predispose to a specific partial supraspinatus tendon tear pattern. The measurements included the critical shoulder angle (CSA), the acromion index (AI), Bigliani acromial type and the new short sclerotic line, acromioclavicular offset angle (ACOA), and AC offset. The ratio length/width of acromion and the medial acromial offset were measured on axial radiographs. A total of 73 patients were allocated to either PASTA (n = 45) or BURSA (n = 28). The short sclerotic line showed a statistically significant difference between PASTA and BURSA (16.2 mm versus 13.1 mm, p = 0.008). The ratio acromial width/length was statistically significant (p = 0.021), with BURSA having slightly greater acromial length (59 vs. 56 mm). The mean acromial offset was 42.9 mm for BURSA vs. 37.7 mm for PASTA (p = 0.021). ACOA and AC offset were both higher for BURSA, without reaching statistical significance. The CSA did not differ significantly between PASTA and BURSA (33.73° vs. 34.56°, p = 0.062). The results revealed an association between a narrow acromial morphology, increased medial offset of the acromion in relation to the glenoid, and the presence of a short sclerotic line in the anteroposterior radiograph in bursal-sided tears of the supraspinatus tendon. Assuming that bursal-sided tears are rather the result of a direct conflict of the tendon with the undersurface of the acromion, this small subgroup of patients presenting with impingement syndrome might benefit from removing a harming acromial spur.
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Billaud A, Lacroix PM, Carlier Y, Pesquer L. How much acromial bone should be removed to decrease the critical shoulder angle? A 3D CT acromioplasty planning study. Arch Orthop Trauma Surg 2022; 142:3909-3915. [PMID: 35088167 DOI: 10.1007/s00402-021-04292-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 11/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND A high critical shoulder angle (CSA) is associated with rotator cuff tear (RCT) and retear rate after repair. CSA reduced to less than 33° by acromioplasty is correlated with better clinical results and healing. But up to 24% of patients retain a CSA above 35° after acromioplasty. The objective of the study was to evaluate the use of 3D when planning acromioplasty and measure acromial bone removal volume dimensions. METHODS Computed tomography (CT) scans from 45 patients with RCT and CSA ≥ 38° were retrospectively included. A 33° CSA cutting plane was positioned. Acromion was divided into 5 mm slices and acromial bone resection measured on each slice. RESULTS Intra- and inter-observer reproducibility measurements were rated strong or very strong. Patients' mean preoperative CSA was 40° (38°, 49° ± 2.3°). Measurements of acromial resection were: anteroposterior length: 32.7 mm (20, 50 ± 7.4); inferior width: 7.6 mm (4.2, 19 ± 2.9); superior width: 4.1 mm (0, 16 ± 3.0); height: 6.1 mm (1.7, 6.7 ± 1.6); and cutting angle: 74° (46, 91 ± 8.0). Maximum width of acromial resection was located 10.6 mm (5, 17.5 ± 0.6) from the acromion's anterior edge and decreased gradually moving posteriorly. Preoperative CSA was linearly correlated with width (P < 0.0001, R = 84%) and length (P = 0.0001, R = 28%) of acromioplasty; the higher the CSA, the greater the width and length. CONCLUSIONS 3D CT reconstructions are valid for planning a CSA decreasing acromioplasty. To reduce CSA to 33°, acromioplasty must be performed anterolaterally and resection is at least 2 cm long anteroposteriorly. For higher CSAs, acromioplasty may require lateral resection over 1 cm in width and up to 5 cm in length. To decrease the CSA efficiently, acromioplasty must be adapted to patient anatomy and 3D planning could be considered. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Anselme Billaud
- Clinique du Sport, 2 rue Georges Negrevergne, 33700, Mérignac, France.
| | | | - Yacine Carlier
- Clinique du Sport, 2 rue Georges Negrevergne, 33700, Mérignac, France
| | - Lionel Pesquer
- Centre d'Imagerie Ostéo-Articulaire, 2 rue Georges Negrevergne, 33700, Mérignac, France
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Acromion morphology affects lateral extension of acromion: A three-dimensional computed tomographic study. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Effect of the Critical Shoulder Angle on the Efficacy of Ultrasound-Guided Steroid Injection for Subacromial Bursitis. J Pers Med 2022; 12:jpm12111879. [PMID: 36579587 PMCID: PMC9692981 DOI: 10.3390/jpm12111879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/29/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
The critical shoulder angle (CSA) is associated with impingement and rotator cuff lesions, and ultrasound-guided corticosteroid injection is effective for subacromial bursitis. However, because the efficacy of this treatment varies, this study investigated the effect of the CSA on the efficacy of corticosteroid injection in the subacromial space. Patients who received a diagnosis of subacromial bursitis after a clinical physical examination and ultrasound were enrolled prospectively from May 2019 to December 2021. Patients’ baseline variables and CSAs were assessed before intervention. Patients’ shoulder pain and disability index (SPADI), visual analog scale (VAS), and shoulder joint range of motion (ROM) scores were assessed at 2, 6, and 12 weeks after ultrasound-guided corticosteroid injection. All participants were divided into CSA > 38° and CSA ≤ 38° groups. We conducted the intragroup and intergroup comparisons of the variables and performed Pearson analysis to identify potential correlations between the CSA and outcome parameters. A total of 55 patients were enrolled in this study. Of these, 28 were included in the CSA > 38° group and 27 in the CSA ≤ 38° group. The baseline variables of the two groups did not differ. In the intragroup and intergroup comparisons, although VAS, SPADI, and ROM scores improved up to 12 weeks after intervention, no difference was identified between groups. The Pearson analysis revealed a positive correlation (r = 0.30, p = 0.024) between the CSA and VAS scores before the intervention. However, no correlation was found between the CSA and follow-up parameters. The CSA was not associated with the clinical efficacy of ultrasound-guided corticosteroid injection for subacromial bursitis.
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Yilmazturk K, Birinci M, Kuyucu E, Bulbul AM. Is shoulder geometry important for rotator cuff tears? Int J Clin Pract 2021; 75:e15005. [PMID: 34739181 DOI: 10.1111/ijcp.15005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 09/23/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study is aiming to evaluate some specific anatomic shoulder parameters such as the lateral acromial angle (LAA), acromial index (AI), coracohumeral distance (CHD) and critical shoulder angle (CSA) in rotator cuff tears. METHODS A total of 100 cases consisting of 50 patients with rotator cuff tears and 50 patients without rotator cuff tears, who underwent shoulder MRI (mangnetic resonance imaging) examination in Istanbul Medipol University Orthopedics and Traumatology Department, participated in this study. In this retrospective study, CCA, LAA, AI and CSA were evaluated in MRI in order to shed light on the theories of rotator cuff tears. RESULTS There was no significant difference (P ˃ .05) in acromial index and coracohumeral distance in the patient group. Lateral acromial angle and critical shoulder angle were significantly different in the patient group compared to the control group (P < .05). There was a weak negative correlation between CSA and CHD. CONCLUSION In our study, we found that patients with smaller LAA and higher CSA values in MRI images are prone to have rotator cuff tears. Further studies are needed in order to evaluate whether this association has predictive value.
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Affiliation(s)
- Kerem Yilmazturk
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
- Clinical Anatomy PhD Program, Graduate School of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Murat Birinci
- Department of Orthopaedics & Traumatology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Ersin Kuyucu
- Medical Park Bahcelievler Hospital, Department of Orthopaedics and Traumatology, Altinbas Universitesi, Istanbul, Turkey
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Loriaud A, Bise S, Meyer P, Billaud A, Dallaudiere B, Silvestre A, Pesquer L. Critical shoulder angle: what do radiologists need to know? Skeletal Radiol 2020; 49:515-520. [PMID: 31745584 DOI: 10.1007/s00256-019-03337-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 02/02/2023]
Abstract
The critical shoulder angle (CSA) constitutes a straightforward and highly reproducible tool. Degenerative rotator cuff tears (RCT) are associated with a significantly larger CSA. In this review, the most relevant features of the CSA are summarized: (1) the relationship between the CSA and RCT pathophysiology, (2) accurate measurement of the CSA according to various imaging modalities, (3) the contribution of the CSA in predicting the occurrence of RCT, and (4) RCT recurrence after surgical repair.
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Affiliation(s)
- Amélie Loriaud
- MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac, 2 rue George Negrevergne, 33700, Merignac, France
| | - Sylvain Bise
- MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac, 2 rue George Negrevergne, 33700, Merignac, France
| | - Philippe Meyer
- MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac, 2 rue George Negrevergne, 33700, Merignac, France
| | - Anselme Billaud
- Orthopedic Surgery Department, Clinique du sport, Bordeaux-Mérignac, 2 rue George Negrevergne, 33700, Mérignac, France
| | - Benjamin Dallaudiere
- MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac, 2 rue George Negrevergne, 33700, Merignac, France
| | - Alain Silvestre
- MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac, 2 rue George Negrevergne, 33700, Merignac, France
| | - Lionel Pesquer
- MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac, 2 rue George Negrevergne, 33700, Merignac, France.
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Billaud A, Cruz-Ferreira E, Pesquer L, Abadie P, Carlier Y, Flurin PH. Does the critical shoulder angle decrease after anterior acromioplasty? Arch Orthop Trauma Surg 2019; 139:1125-1132. [PMID: 30868217 DOI: 10.1007/s00402-019-03163-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION No clinical studies to date have analyzed the critical shoulder angle (CSA) following anterior acromioplasty. Our study's main objective was to measure the change in the CSA after acromioplasty. MATERIALS AND METHODS Ninety patients were included in this retrospective series. The CSA and the type of acromion were evaluated before and after surgery. RESULTS The average CSA for patients before surgery was 35.9° (± 3.7, 26.2, 44.2) and 33° after the acromioplasty (± 3.5, 24.8, 41.4). The decrease was significant and 2.9° on average (± 2.2, - 2.2, 11.9, p = 0.000). Preoperatively, 58% of patients had a CSA ≥ 35° (n = 52) and 24% postoperatively (n = 22, p = 0.000). CONCLUSIONS Standardized anterior acromioplasty allows for a significant decrease in the CSA without lateral resection of the acromion. This study confirms the tight link between the CSA and the anterior acromion as well as the interest of this angle to quantify acromioplasty whether anterior or lateral. LEVEL OF EVIDENCE Level IV, Case Series, Retrospective design.
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Affiliation(s)
- Anselme Billaud
- Clinique du Sport-CCOS, 2 Rue Georges Negrevergne, 33700, Mérignac, France.
| | | | - Lionel Pesquer
- Clinique du Sport-CCOS, 2 Rue Georges Negrevergne, 33700, Mérignac, France
| | - Pierre Abadie
- Clinique du Sport-CCOS, 2 Rue Georges Negrevergne, 33700, Mérignac, France
| | - Yacine Carlier
- Clinique du Sport-CCOS, 2 Rue Georges Negrevergne, 33700, Mérignac, France
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Kuper G, Shanmugaraj A, Horner NS, Ekhtiari S, Simunovic N, Cadet ER, Ayeni OR. Critical shoulder angle is an effective radiographic parameter that is associated with rotator cuff tears and osteoarthritis: a systematic review. J ISAKOS 2019. [DOI: 10.1136/jisakos-2018-000255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Totlis T, Gowd AK, Bernardoni ED, Cole BJ, Verma NN, Natsis K. A simple method to directly evaluate the lateral extension of the acromion: an anatomic study of 128 cadaveric scapulae. J Shoulder Elbow Surg 2018; 27:1694-1699. [PMID: 29730136 DOI: 10.1016/j.jse.2018.02.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The lateral extension of the acromion from the glenohumeral joint is the critical variable that both the acromial index and critical shoulder angle reflect. The purpose of this study was to establish a simple and reproducible method to directly measure the lateral extension of the acromion that will be independent of patient demographic characteristics, scapular rotation, or other morphologic features of the shoulder. METHODS This study used 128 unpaired cadaveric scapulae with a mean age of 69.4 ± 11.1 years (66 right and 62 left scapulae, 65 female and 63 male cadaveric specimens). The lateral extension of the acromion was measured from the supraglenoid tubercle to the most lateral point of the acromion with a digital caliper placed perpendicular to the scapula long axis. This distance was called the "lateral offset of the acromion." RESULTS The lateral offset was 2.62 ± 0.72 cm in men and 2.69 ± 0.73 cm in women. The offset was 2.61 ± 0.66 cm in right and 2.70 ± 0.78 cm in left scapulae. The offset in the group aged 46-60 years was 2.85 ± 0.76 cm; in the group aged 61-75 years, it was 2.62 ± 0.76 cm; and in the group aged 76 years or older, it was 2.54 ± 0.60 cm. No significant difference was found between any of the groups. CONCLUSIONS This study established a simple method to directly measure the lateral extension of the acromion based on the longitudinal axis of the scapula, which eliminates bias that may exist in the acromial index and critical shoulder angle from the position of the scapula and glenoid inclination. The lateral offset was found to be independent of sex, side, or age, limiting bias in a potential future clinical application.
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Affiliation(s)
- Trifon Totlis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anirudh K Gowd
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Eamon D Bernardoni
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Multimodality imaging of subacromial impingement syndrome. Skeletal Radiol 2018; 47:923-937. [PMID: 29445933 DOI: 10.1007/s00256-018-2875-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/26/2017] [Accepted: 01/02/2018] [Indexed: 02/02/2023]
Abstract
Subacromial impingement syndrome results from irritation of the tendons of the rotator cuff muscles in the subacromial space and may manifest as a range of pathologies. However, subacromial impingement is a dynamic condition for which imaging reveals predisposing factors but no pathognomonic indicators. Also, the usual imaging features of subacromial impingement may be seen in symptomatic and asymptomatic patients. Therefore, imaging is able to detect tears and describe the risk factors of impingement but cannot confirm subacromial impingement. Radiographs allow assessment of the morphology of the acromion and its lateral extension by means of the acromial index and the critical shoulder angle, which may increase in cases of subacromial impingement. Ultrasound is necessary to evaluate a tendon tear and is the only tool that provides dynamic information, which is essential to assessing dynamic conditions. Magnetic resonance imaging (MRI) allows the assessment of associated intraarticular abnormalities, joint effusion, and bone marrow edema. The objective of this article is to provide an overview of the pathophysiology and clinical manifestations of subacromial impingement and discuss recent advances in the imaging of subacromial impingement and the role of radiography, ultrasound, and MRI in differentiating normal from pathologic findings.
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Dietrich TJ, Jonczy M, Buck FM, Sutter R, Puskas GJ, Pfirrmann CWA. Ultrasound of the coracoacromial ligament in asymptomatic volunteers and patients with shoulder impingement. Acta Radiol 2016; 57:971-7. [PMID: 26508794 DOI: 10.1177/0284185115610930] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 09/17/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND The coracoacromial ligament is part of the coracoacromial arch, which is considered to be involved in shoulder impingement. PURPOSE To compare the coracoacromial ligament on ultrasound in asymptomatic volunteers and in patients with subacromial shoulder impingement. MATERIAL AND METHODS Twenty-nine asymptomatic volunteers (mean age, 35.5 years) and 29 patients (mean age, 49.9 years) with shoulder impingement, diagnosed by experienced shoulder surgeons, were prospectively included. Two radiologists obtained and analyzed ultrasound images of the coracoacromial ligament in the longitudinal axis. RESULTS The ligament thickness was 1.4 ± 0.2 mm at its midportion, 1.8 ± 0.4 mm at the coracoid, and 2.1 ± 0.6 mm at the acromion in asymptomatic volunteers compared with 1.3 ± 0.2 mm, 1.9 ± 0.5 mm, and 1.9 ± 0.5 mm in impingement patients for observer 1. The ligament length was 30.6 ± 2.4 mm in asymptomatic volunteers compared with 30.4 ± 3.6 mm in impingement patients for observer 1. An anteriorly convex shape of the superficial contour of the coracoacromial ligament was significantly more frequent in impingement patients compared with asymptomatic volunteers for both observers (observer 1: 10% (3/29) versus 45% (13/29), P value <0.01; observer 2: 10% (3/29) versus 38% (11/29), P value <0.03). The comparison of the remaining parameters of the coracoacromial ligament, such as the thickness, length, echogenicity, and fibrillation did not reveal significant differences between volunteers and patients. CONCLUSION While thickness or length of the coracoacromial ligament were similar in volunteers and patients with shoulder impingement, an anteriorly convex shape of the superficial contour of the coracoacromial ligament was significantly more frequent in impingement patients compared with asymptomatic volunteers.
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Affiliation(s)
- Tobias J Dietrich
- Radiology, Orthopedic University Hospital Balgrist, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Maciej Jonczy
- Radiology, Orthopedic University Hospital Balgrist, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Florian M Buck
- Radiology, Orthopedic University Hospital Balgrist, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Radiology, Orthopedic University Hospital Balgrist, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Gabor J Puskas
- Orthopedic Surgery, Orthopedic University Hospital Balgrist, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christian WA Pfirrmann
- Radiology, Orthopedic University Hospital Balgrist, Faculty of Medicine, University of Zurich, Zurich, Switzerland
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