Aims and objectives
Subacromial impingement syndrome (SIS) and the related rotator cuff tears (RCTs) are the most common cause of pain and shoulder disability [1].
SIS exhibits a multifactorial pathogenesiswith intrinsic [2,3] and extrinsic impingement factors,
including anatomical characteristic of shoulder bony structures that result in subacromial space narrowing to be the primary cause [4-9].
Several studies discussed the morphological differences in acromion structure and their effect on pathogenesis of SIS.
Special angles and distances have been proposed to evaluate the SIS [5,9] on conventional X-ray and MDCT....
Methods and materials
The study enrolled 128 patients with chronic shoulder pain (61 male and 67 female),
with a mean age of 57 years (from 18 to 83 years)
and 35 asymptomatic patients with a mean age of 56 years (from 45 to 87 years).
All patients were examined by traumatologist and underwent complex examination using the following methods: conventional shoulder radiography,
ultrasound examination,
MRI,
MDCT, MR-arthrography,
followed by arthroscopy.
To establish bone-cartilaginous element’s condition and the type of tendon/ligament changes MDCT and MR-arthography and arthroscopy were performed....
Results
RCT were found in 69 patients (53.9% of cases): among them 56 full and 13 partial tears.
In 59 patients (46.1%) RCT were not identified. 34 patients were found to have degenerative changes or articular tears.
Acromial inferior protrusion (AIP) showed significant statistical differences among the patients with SIS and control group.
Mean values for the AT angle were significantly lower in the SIS patients – 25.90±4.27 than in the control group – 29.41±4.07˚,
with the level of significance P= 0.0026.
The AS indicator showed...
Conclusion
AT and CSA could be recommended for clinical use to identify SIS and rotator cuff tears.
AHD measurement could also be recommended to differentiate the presence or absence of SIS,
but not for rotator cuff tears prediction.
Acromion type identification using AN and LAA values could only be recommended while taking the age factor into account (considering younger patients may have lower values than more senior ones).
Personal information
1.
Professor,
Dr.
Veronika Gazhonova,
MD,
PhD,
Radiology Chair,
Postgraduate Medical Education,
Moscow,
Russia.
Her areas of clinical interest are innovations in ultrasonography,
including 3D US,
sonoelastography,
US-guided procedures,
contrast US,
hybrid US technologies.
Contacts:
[email protected].
2.
Dr.
Mikhail Emelianenko,
MD,
PhD,
is an orthopaedic surgeon at the United Hospital and Policlinic,
Moscow,
Russia.
His areas of interest are shoulder and knee arthroscopy,
sports traumatology.
Dr.
Emelianenko is a member of European Society of Sports Traumatology,
Knee Surgery and Arthroscopy (ESSKA) and Association of Sports...
References
1. Van der Windt,
D.A.,
Koes,
B.W.,
de Jong,
B.A.,
Bouter,
L.M.,
1995.
Shoulder disorders in general practice: incidence,
patient characteristics,
and management.
Ann.
Rheum.
Dis.
54,
959–964.
2. Ozaki J,
Fujimoto S,
Nakagawa Y,
Masuhara K,
Tamai S Tears of the rotator cuff of the shoulder associated with pathological changes in the acromion.
A study in cadavera.
J Bone Joint Surg (Am) 1988;70:1224–1230
3. Ogata S,
Uhthoff HK Acromial enthesopathy and rotator cuff tear.
A radiologic and histologic postmortem investigation of the coracoacromial arch....