Skip to main content
SpringerLink
Log in

Bildgebende Verfahren bei Rotatorenmanschettendefekten der Schulter

Imaging in evaluating rotator cuff tears

  • Leitthema
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Vor der Indikation zur bildgebenden Diagnostik steht die klinisch begründete Verdachtsdiagnose. Die Basis der bildgebenden Diagnostik bei Rotatorenmanschettendefekten bilden die konventionelle Röntgendiagnostik und die Sonographie. Für spezielle Fragestellungen bietet sich die Kernspintomographie an. Sehnentotaldefekte können sowohl im MRT als auch mit der Sonographie mit großer Sicherheit erkannt werden. Die Diagnostik von Partialdefekten der Manschette ist weiterhin verbesserungswürdig. Die Sicherheit des nativen MRT in der Diagnostik von Partialdefekten kann sowohl durch die indirekte als auch die direkte MR-Arthrographie deutlich gesteigert werden. Nur die Sonographie bietet bislang die Möglichkeit, im Echtzeitverfahren am bewegten Gelenk zu untersuchen. Mit der dynamischen Muskelsonographie sind zusätzliche Möglichkeiten gegeben, die Funktionsfähigkeit der Muskulatur zu erfassen. Der Einsatz der MRT als Screeningmethode sollte unterbleiben, da mit ihrer Hilfe keine therapeutisch relevanten Informationen gewonnen werden.

Abstract

Diagnostic imaging in a patient with shoulder pain should be used only after a comprehensive clinical evaluation of the shoulder. X-ray and ultrasonography are the basic diagnostic tools; computed tomography and magnetic resonance imaging (MRI) should be used only with certain indications. Ultrasonography and MRI have comparable accuracy for identifying and measuring full-thickness rotator cuff tears, but the accuracy for identifying partial-thickness still needs to be improved. MR arthrography has significantly improved sensitivity and specificity for partial-thickness tears of the cuff. Only ultrasound provides a real-time examination tool during shoulder movements. Moreover, dynamic ultrasonography can assess the contraction patterns of the supraspinatus and infraspinatus muscles, which may improve decision making in the treatment of shoulder diseases. In depicting fatty atrophy of the supraspinatus and infraspinatus muscles, MRI remains the reference standard. MRI should not be used as a diagnostic screening tool in patients with chronic shoulder pain because it does not appear to significantly affect treatment or outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10
Abb. 11
Abb. 12
Abb. 13
Abb. 14
Abb. 15
Abb. 16
Abb. 17

Literatur

  1. Bachmann G, Bauter T, Jürgensen I et al. (1998) Diagnostische Sicherheit und therapeutische Relevanz von CT-Arthrographie und MR-Arthrographie der Schulter RöFo 168: 149–156

  2. Bandi W (1981) Die Läsion der Rotatorenmanschette. Helv Chir Acta 48: 537–549

    Google Scholar 

  3. Bigliani LU, Morrison DS, April EW (1986) The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 10: 228

    Google Scholar 

  4. Böhm, TD, Kirschner S, Müller T et al. (2005) Dynamic ultrasonography of rotator cuff muscles. J Clin Ultrasound 33: 207–213

    Article  Google Scholar 

  5. Bradley MP, Tung G, Green A (2005) Overutilization of shoulder magnetic resonance imaging as a diagnostic screening tool in patients with chronic shoulder pain. J Shoulder Elbow Surg 14(3): 233–237

    Article  PubMed  Google Scholar 

  6. Brenneke StL, Morgan CJ (1992) Evaluation of ultrasonography as a diagnostic technique in the assessment of rotator cuff tendons. Am J Sports Med 20: 287–289

    Article  PubMed  CAS  Google Scholar 

  7. Bretzke CA, Crass JR, Craig EV,Feinberg SB (1985) Ultrasonography of the rotator cuff: normal and pathologic anatomy. Invest Radiol 20: 311–315

    Article  PubMed  CAS  Google Scholar 

  8. Burk DL, Karasick D, Kurtz AB et al. (1989) Rotator cuff tears: Prospective comparison of MR imaging with arthrography, sonography, and surgery. AJR 153: 87–92

    PubMed  Google Scholar 

  9. Charousset C, Bellaiche L, Duranthon LD, Grimberg J (2005) Accuracy of CT arthrography in the assessment of tears of the rotator cuff. J Bone Joint Surg Br 87: 824–828

    PubMed  CAS  Google Scholar 

  10. Cotton RE, Rideout DF (1964) Tears of the humeral rotator cuff. A radiological and pathological necropsy survey. J Bone Joint Surg Br 46: 314–328

    PubMed  CAS  Google Scholar 

  11. Crass JR, Craig EV, Thompson R, Feinberg SB (1984) Ultrasonography of the rotator cuff: surgical correlation. J Clin Ultrasound 12: 487–492

    Article  PubMed  CAS  Google Scholar 

  12. Deutsch A, Altcheck DW, Schwartz E et al. (1996) Radiologic measurement of superior displacement of the humeral head in the impingement syndrome. J Should Elbow Surg 5(3): 186–193

    Article  CAS  Google Scholar 

  13. Dinnes J, Loveman E, McIntyre L, Waugh N (2003) The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technology Assess 4: 1–166

    Google Scholar 

  14. Dorgan JA (1955) Posterior dislocation of the shoulder. Am J Surg 89(4): 890–900

    Article  PubMed  CAS  Google Scholar 

  15. Drakeford KM, Quinn MJ, Simpson SL, Pettine KA (1990) A comparative study of ultrasonography and arthrography in evaluation of the rotator cuff. Clin Orthop 253: 118–122

    PubMed  Google Scholar 

  16. Farin PU, Jaroma H (1995) Acute traumatic tears of the rotator cuff: value of sonography. Radiology 197(1): 269–273

    PubMed  CAS  Google Scholar 

  17. Farin PU, Kaukanen E, Jaroma H et al. (1996) Site and size of rotator-cuff tear. Findings at ultrasound, double-contrast arthrography, and computed tomography arthrography with surgical correlation. Invest Radiol 7: 387–394

    Article  Google Scholar 

  18. Fuchs B, Weishaupt D, Zanetti M et al. (1999) Fatty degeneration of the muscles of the rotator cuff: Assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8: 599–605

    Article  PubMed  CAS  Google Scholar 

  19. Gazielly DF, Gleyze P, Montagnon C (1994) Functional and anatomical results after rotator cuff repair. Clin Orthop 304: 43–53

    PubMed  Google Scholar 

  20. Ghelman B, Goldman AB (1977) The double contrast shoulder arthrogram: evaluation of rotator cuff tears. Radiology 124: 251–254

    PubMed  CAS  Google Scholar 

  21. Goutallier D, Bernageau J, Patte D (1989) L’évaluation par le scanner de la trophicité des muscles des coiffes des rotateurs ayant une rupture tendineuse. Rev Chir Orthop 75 (Suppl 1): 126–127

    Google Scholar 

  22. Goutallier D, Postel JM, Laveau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT-scan. Clin Orthop 304: 78–83

    PubMed  Google Scholar 

  23. Harland U (1988) Die Abhängigkeit der Echogenität vom Anschallwinkel an Muskulatur und Sehnengewebe. Z Orthop 126: 117–124

    PubMed  CAS  Google Scholar 

  24. Hedtmann A, Fett H (1988). Dynamische Ultraschalluntersuchung. In: Maaz B, Stahl C (Hrsg) Apparative Diagnostik des Schultergelenks. Thieme, Stuttgart, S 34–42

  25. Hedtmann A, Fett H (1990) Schultersonographie. In: Hedtmann A (Hrsg) Degenerative Schultererkrankungen. Enke, Stuttgart, S 37–44

  26. Hedtmann A, Fett H (1991) Atlas und Lehrbuch der Schultersonografie, 2. Aufl. Enke, Stuttgart

  27. Hedtmann A, Fett H (1995) Schultersonografie bei Subakromialsyndromen mit Erkrankungen und Verletzungen der Rotatorenmanschette. Orthopäde 24: 498–508

    PubMed  CAS  Google Scholar 

  28. Hedtmann A, Weber A, Schleberger R, Fett H (1986) Ultraschalluntersuchung des Schultergelenks. Orthopädische Praxis 22: 647–661

    Google Scholar 

  29. Heers G, Götz J, Anders S et al. (2006) Ultrasound evaluation of the acromioclavicular joint--a correlation of anatomical and sonographical findings. Ultraschall Med 27(6): 549–542

    Article  Google Scholar 

  30. Herold T, Caro WC, Heers G et al. (2004) Influence of sequence type on the extent of the susceptibility artifact in MRI--a shoulder specimen study after suture anchor repair. Rofo 176(9): 1296–1301

    PubMed  CAS  Google Scholar 

  31. Herold T, Bachthaler M, Hamer OW et al. (2006) Indirect MR arthrography of the shoulder: use of abduction and external rotation to detect full- and partial thickness tears of the supraspinatus tendon. Radiology 240: 152–160

    Article  PubMed  Google Scholar 

  32. Hodler J, Fretz CJ, Terrier F, Gerber C (1988) Rotator cuff tears: correlation of sonographic and surgical findings. Radiology

  33. Hodler J, Kursunoglu-Brahme S, Snyder SJ et al. (1992) Rotator cuff disease: assessment with MR arthrography versus standard MR imaging in 36 patients with arthroscopic confirmation Radiology 182: 431–436

  34. Iannotti JP, Zlatkin MB, Esterhai JL et al. (1991) Magnetic resonance imaging of the shoulder. Sensitivity, specificity, and predictive value. J Bone Joint Surg 73: 17–29

    PubMed  CAS  Google Scholar 

  35. Iannotti JP, Ciccone J, Buss DD et al. (2005) Accuracy of office-based ultrasonography of the shoulder for the diagnosis of rotator cuff tears. J Bone Joint Surg Am 87: 1305–1311

    Article  PubMed  Google Scholar 

  36. Juul-Kristensen B, Bojsen-Möller F, Holst E, Ekdahl C (2000) Comparison of muscle sizes and moment arms of two rotator cuff muscles measured by ultrasonography and magnetic resonance imaging. Eur J Ultrasound 11: 161–173

    Article  PubMed  CAS  Google Scholar 

  37. Katthagen BD (1988) Schultersonographie. Thieme, Stuttgart

  38. Kijowski R, Farber JM, Medina J et al. (2005) Comparison of fat-suppressed T2-weighted fast spin-echo sequence and modified STIR sequence in the evaluation of the rotator cuff tendon.AJR Am J Roentgenol. 185(2): 371–378

    Google Scholar 

  39. Kjellin I, Ho CP, Cervilla V et al. (1991) Alterations in the supraspinatus tendon at MR imaging: correlation with histopathologic findings in cadavers. Radiology 181: 837–841

    PubMed  CAS  Google Scholar 

  40. Knudsen HB, Gelineck J, Sojbjerg JO et al. (1999) Functional and magnetic resonance imagin evaluation after single-tendon rotator cuff reconstruction. J Shoulder Elbow Surg 8: 242–246

    Article  PubMed  CAS  Google Scholar 

  41. Kurol M, H Rahme, S Hilding (1991) Sonography for diagnosis of Rotator Cuff Tear. Acta Orthop Scand 62: 465–467

    Article  PubMed  CAS  Google Scholar 

  42. Lindblom K, Palmer I (1938) Ruptures of the tendon aponeurosis of the shoulder joint –the so-called supraspinatus ruptures. Acta Chir Scand 82: 133–142

    Google Scholar 

  43. Mack LA, Matsen FA, Kilcoyne RF et al. (1985) Ultrasound evaluation of the rotator cuff. Radiology 157: 205

    PubMed  CAS  Google Scholar 

  44. Mack LA, MK Gannon, RF Kilcoyne, FA Matsen (1988) Sonographic Evaluation of the Rotator Cuff: Accuracy in Patients without prior Surgery. Clin Orthop 234: 21–27

    PubMed  Google Scholar 

  45. Meister K, Thesing J, Montgomery WJ et al. (2004) MR arthrography of partial thickness tears of the undersurface of the rotator cuff: an arthroscopic correlation. Skeletal Radiol 33: 136–141

    Article  PubMed  Google Scholar 

  46. Middleton WD, Edelstein G, Reinus WR et al. (1985) Sonographic detection of rotator cuff tears. AJR Am J Roentgenol 144(2): 349–53

    PubMed  CAS  Google Scholar 

  47. Middleton WD, Reinus WR, Totty WG et al. (1986) Ultrasonographic evaluation of the rotator cuff and biceps tendon. J Bone Joint Surg Am 68(3): 440–450

    PubMed  CAS  Google Scholar 

  48. Misamore GW, Woodward C (1991) Evaluation of degenerative lesions of the rotator cuff. J Bone Joint Surg 73: 704–706

    PubMed  CAS  Google Scholar 

  49. Müller T, Gohlke F, Kenn W (1996) Stellenwert der Magnetresonanztomographie. In: Eulert J, Hedtmann A (Hrsg.) Das Impingementsyndrom der Schulter. Thieme, Stuttgart

  50. Nakagaki K, Ozaki J, Tomita Y, Tamai S (1994) Alterations in the supraspinatus muscle belly with rotator cuff tearing: evaluation with magnetic resonance imaging. J Shoulder Elbow Surg 3: 88

    Google Scholar 

  51. Nelson MC, Leather GP, Nirschl RP et al. (1991) Evaluation of the painful shoulder. A prospective comparison of magnetic resonance imaging, computerized tomographic arthrography, ultrasonography, and operative findings. J Bone Joint Surg 73: 707–716

    PubMed  CAS  Google Scholar 

  52. Neumann CH, Holt RG, Steinbach LS et al. (1992) MR imaging of the shoulder: appearance of the supraspinatus tendon in asymptomatic volunteers. AJR Am J Roentgenol 158: 1281–1287

    PubMed  CAS  Google Scholar 

  53. Newberg AH, Munn CS, Robbins AH (1985) Complications of arthrography. Radiology 157: 605–606

    Google Scholar 

  54. OberholzerJ (1933) Die Arthrosonographie bei habitueller Schulterluxation. Röntgenpraxis 5: 589–590

    Google Scholar 

  55. O’Connor PJ, Rankine J, Gibbon WW et al. (2005) Interobserver variation in sonography of the painful shoulder. Clin J Ultrasound 33(2): 53–56

    Article  Google Scholar 

  56. Olive RJ, HO Marsh (1992) Ultrasonography of rotator cuff tears. Clin Orthop 282: 110–113

    PubMed  Google Scholar 

  57. Palmer WE, Brown JH, Rosenthal DI (1993) Rotator cuff: evaluation with fat-suppressed MR arthrography. Radiology 188: 683–687

    PubMed  CAS  Google Scholar 

  58. Pattee GA, Snyder St (1988) Sonographic evaluation of the rotator cuff: correlation with arthroscopy. Arthroscopy 4: 15–20

    Article  PubMed  CAS  Google Scholar 

  59. Plafki C, Hedtmann A, Fett H et al. (1997) Ergebnisse der operativen Therapie von Rupturen der Rotatorenmanschette der Schulter. Z Orthop 135: 360–367

    PubMed  CAS  Google Scholar 

  60. Preston BJ, Jackson JP (1977) Investigation of shoulder disability by arthrography. Clin Radiol 2: 259–266

    Article  Google Scholar 

  61. Rafii M, Firooznia H, Sherman O et al. (1990) Rotator cuff lesions: signal patterns at MR imaging. Radiology 177: 817–823

    PubMed  CAS  Google Scholar 

  62. Rapf C, Furtschegger A, Resch H (1986) Die Sonographie als neues diagnostisches Verfahren zur Abklärung von Schulterbeschwerden. Fortschr Röntgenstr 145: 288–295

    Article  CAS  Google Scholar 

  63. Read JW, Perko M (1998) Shoulder ultrasound: Diagnostic accuracy for impingement syndrome, rotator cuff ear and biceps tendon pathology. J Shoulder Elbow Surg 7: 264–271

    Article  PubMed  CAS  Google Scholar 

  64. Reinus WR, Shady KL, Mirowitz SA, Totty WG (1995) MR diagnosis of rotator cuff tears of the shoulder: value of using T2-weighted fat-saturated images. AJR AmJ Roentgenol 164: 1451–1455

    CAS  Google Scholar 

  65. Rockwood CA (1984) Injuries to the acromioclavicular joint. In: Rockwood CA, Greene DP (Hrsg.): Fractures in Adults, Vol. 1, 1. Aufl., Lippincott, Philadelphia, pp 869–872

  66. Sahin-Akyar G, Miller TT, Staron RB et al. (1998) Gradient-echo versus fat-suppressed fast spin-echo MR imaging of rotator cuff tears. AJR Am J Roentgenol 171(1): 223–227

    PubMed  CAS  Google Scholar 

  67. van de Sande MA, Rozing PM (2006) Proximal migration can be measured accurately on standardized anteroposterior shoulder radiographs. Clin Orthop Relat Res 443: 260–265

    Article  Google Scholar 

  68. Schlepckow P, Reichelt A., Hellige R. (1987) Erste Erfahrung in der Diagnostik der RM-Ruptur. In: HR Henche, W. Hey (Hrsg.) Sonografie in der Orthopädie und Sportmedizin. ML-Verlag, Uelzen, S 31–34

  69. Seeger LL, Lubowitz J, Thomas BJ (1993) Case report 815: Tear of the rotator interval. Skeletal Radiol 22(8): 615–617

    Article  PubMed  CAS  Google Scholar 

  70. Sher JS, Iannotti JP, Williams GR et al. (1998) The effect of shoulder magnetic resonance imaging on clinical decision making. J Shoulder Elbow Surg 7: 205–209

    Article  PubMed  CAS  Google Scholar 

  71. Sperner G, Resch H, Golser K et al. (1993). Die Wertigkeit der Sonographie bei Rupturen der Rotatorenmanschette. Unfallchirurg 96: 119–123

    PubMed  CAS  Google Scholar 

  72. Strobel K, Hodler J, Meyer DC et al. (2005) Fatty atrophy of supraspinatus and infraspinatus muscles: accuracy of US. Radiology 237(2): 584–589

    Article  PubMed  Google Scholar 

  73. Swen WA, Jacobs JW, Algra PR et al. (1999) Sonography and magnetic resonance imaging equivalent for the assessment of full-thickness rotator cuff tears. Arthritis Rheum 42: 2231–2238

    Article  PubMed  CAS  Google Scholar 

  74. Teefey SA, Hasa SA, Middleton WD et al. (2000) Ultrasonography of the rotator cuff. A comparison of ultrasonographic and arthroscopic findings in one hundred consecutive cases. J Bone Joint Am 82: 484–504

    Google Scholar 

  75. Teefey SA, Rubin DA, Middleton WD et al. (2004) Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy one consecutive cases. J Bone Joint Surg Am 86: 708–716

    PubMed  Google Scholar 

  76. Thomazeau H, Rolland Y, Lucas C et al. (1996) Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand 67: 264–268

    Article  PubMed  CAS  Google Scholar 

  77. Thomazeau H, Boukobza E, Morcet N et al. (1997) Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop 344: 275–283

    PubMed  Google Scholar 

  78. Timins ME, Erickson SJ, Estkowski LD et al. (1995) Increased signal in the normal supraspinatus tendon on MR imaging: diagnostic pitfall caused by the magic-angle effect. AJR Am J Roentgenol 165: 109–114

    PubMed  CAS  Google Scholar 

  79. Torstensen ET, Hollinshead RM (1999) Comparison of magnetic resonance imaging and arthroscopy in the evaluation of shoulder pathology. J Shoulder Elbow Surg 8: 42–45

    Article  PubMed  CAS  Google Scholar 

  80. Tyson LL, Crues JV (1993) Pathogenesis of rotator cuff disorders. Magnetic resonance imaging characteristics. Magn Reson Imaging Clin North Am 1: 37–46

    CAS  Google Scholar 

  81. Vahlensieck M, Resendes M, Lang P, Genant H (1992) Shoulder MRI: the subacromial/subdeltoid bursa fat stripe in healthy and pathologic conditions. Eur J Radiol 14: 223–227

    Article  PubMed  CAS  Google Scholar 

  82. van Holsbeeck MT, Kolowich PA, Eyler WR et al. (1995) Vanderschuren GM, Bouffard JA: US depiction of partial rotator cuff tear of the rotator cuff. Radiology 197: 443–446

    Google Scholar 

  83. Vick CW, Bell SA (1990) Rotator cuff tears: Diagnosis with sonography. AJR Am J Roentgenol 154: 121–123

    PubMed  CAS  Google Scholar 

  84. Weishaupt D, Zanetti M, Tanner A et al. (1999) Lesions of the reflection pulley of the long biceps tendon. MR arthrographic findings. Invest Radiol 34: 463–469

    Article  PubMed  CAS  Google Scholar 

  85. Wiener SN, Seitz WH (1993) Sonography of the Shoulder in Patients With Tears of the Rotator Cuff: Accuracy and Value for Surgical Options. AJR Am J Roentgenol160: 103–107

    Google Scholar 

  86. Wijnbladh H (1933) Zur Röntgendiagnose von Schulterluxationen. Chirurg 5: 702

    Google Scholar 

  87. Wülker N, Melzer C, Wirth CJ (1991) Shoulder surgery for rotator cuff tears. Acta Orthop Scand 62: 142–147

    Article  PubMed  Google Scholar 

  88. Wülker N, Roetmann B, Schmitzer H, Roessig S (1995) Coracoacromial pressure recordings in an expermental shoulder model. J Shoulder Elbow Surg 4: 462–467

    Article  Google Scholar 

  89. Zanca P (1971) Shoulder pain: involvement of the acromioclavicular joint (Analysis of 1,000 cases). Am J Roentgenol Radium Ther Nucl Med 112(3): 493–506

    PubMed  CAS  Google Scholar 

  90. Zanetti M, Gerber C, Hodler J (1998) Quantitative assessment of the muscles of the rotator cuff with MR imaging. Invest. Radiol 33: 163–170

    CAS  Google Scholar 

  91. Zanetti M, Jost B, Lustenberger A, Hodler J (1999) Clinical impact of MR arthrography of the shoulder. Acta Radiol. 40: 296–302

    Google Scholar 

  92. Zlatkin MB, Dalinka MK, Kressel HY (1989) Magnetic resonance imaging of the shoulder. [Review] Magn Reson Q 5: 3–22

    Google Scholar 

  93. Zlatkin MB, Ianotti JP, Esterhai JL et al. (1990) Evaluation of rotator cuff disease and glenohumeral instability with MR imaging: correlation with arthroscopy and arthrotomy in a large population of patients [abstr]. Magn Reson Imaging 8 (Suppl 1): 78

    Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Orthopädische Abteilung Klinik Fleetinsel Hamburg, Admiralitätstraße 3, 20249, Hamburg, Deutschland

    A. Hedtmann & G. Heers

Authors
  1. A. Hedtmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Heers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Hedtmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hedtmann, A., Heers, G. Bildgebende Verfahren bei Rotatorenmanschettendefekten der Schulter. Orthopäde 36, 796–809 (2007). https://doi.org/10.1007/s00132-007-1138-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-007-1138-8

Schlüsselwörter

Keywords

Search

Navigation