The value of radiographic markers in the diagnostic work-up of rotator cuff tears, an arthroscopic correlated study

Objective To evaluate the value of radiographs during the diagnostic work-up of rotator cuff tears, using arthroscopy as reference standard. Materials and methods This retrospective study included 236 shoulders of 236 patients. All radiographs were evaluated for inferior cortical acromial sclerosis,...

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Bibliographic Details
Published in:Skeletal radiology 2020-01, Vol.49 (1), p.55-64
Main Authors: van der Reijden, Jeroen J., Nienhuis, Syert L., Somford, Matthijs P., van den Bekerom, Michel P. J., Doornberg, Job N., van ‘t Riet, Esther, van den Borne, Maaike P. J.
Format: Article
Language:English
Subjects:
Arthroscopy
Correlation analysis
Cortex
Cysts
Diagnostic imaging
Diagnostic systems
Humerus
Imaging
Injuries
Magnetic resonance imaging
Medical diagnosis
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Migration
Nuclear Medicine
Orthopedics
Pathology
Radiographs
Radiography
Radiology
Rotator cuff
Scientific
Scientific Article
Sclerosis
Shoulder
Ultrasound
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Summary:Objective To evaluate the value of radiographs during the diagnostic work-up of rotator cuff tears, using arthroscopy as reference standard. Materials and methods This retrospective study included 236 shoulders of 236 patients. All radiographs were evaluated for inferior cortical acromial sclerosis, lateral acromial spur, superior migration of the humeral head, greater tubercle cysts, and subacromial space calcifications. Predictive value of these radiographic signs in predicting rotator cuff tears was determined with arthroscopy as reference standard. Results According to arthroscopy, 131 shoulders were diagnosed with rotator cuff tears. Seventy-two out of 131 shoulders (55%) had inferior cortical acromial sclerosis, 37 (28%) lateral acromial spur, 21 (16%) superior migration of the humeral head, 7 (5%) greater tubercle cysts and 15 subacromial space calcifications (11%). Inferior cortical acromial sclerosis ( P  = 0.001), lateral spur (P = 0.001), superior migration ( P  = 0.002), and cysts ( P  = 0.03) were significantly and independently associated with rotator cuff tears, whereas subacromial calcifications ( p  = 0.21) was not. Inferior cortical acromial sclerosis, superior migration, lateral acromial spur, and cysts combined have a positive predictive value of 78%. Conclusions The combination of inferior cortical acromial sclerosis, lateral acromial spur, superior migration of the humeral head, and greater tubercle cysts has a high positive predictive value for the presence of full-thickness rotator cuff tears. In patients with a high suspicion for having a rotator cuff tear based on radiographic findings, MRI can be performed directly without the delay and costs caused by an additional ultrasound exam.
ISSN:0364-2348
1432-2161
DOI:10.1007/s00256-019-03251-8