Der Orthopäde

, Volume 36, Issue 9, pp 796–809

Bildgebende Verfahren bei Rotatorenmanschettendefekten der Schulter

Leitthema

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.

Schlüsselwörter

Schulter MRT Ultraschall Röntgen Bildgebung 

Imaging in evaluating rotator cuff tears

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.

Keywords

Shoulder MRI Ultrasound X-ray Imaging 

Literatur

  1. 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: 149–156Google Scholar
  2. 2.
    Bandi W (1981) Die Läsion der Rotatorenmanschette. Helv Chir Acta 48: 537–549Google Scholar
  3. 3.
    Bigliani LU, Morrison DS, April EW (1986) The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 10: 228Google Scholar
  4. 4.
    Böhm, TD, Kirschner S, Müller T et al. (2005) Dynamic ultrasonography of rotator cuff muscles. J Clin Ultrasound 33: 207–213CrossRefGoogle Scholar
  5. 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): 233–237PubMedCrossRefGoogle Scholar
  6. 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: 287–289PubMedCrossRefGoogle Scholar
  7. 7.
    Bretzke CA, Crass JR, Craig EV,Feinberg SB (1985) Ultrasonography of the rotator cuff: normal and pathologic anatomy. Invest Radiol 20: 311–315PubMedCrossRefGoogle Scholar
  8. 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: 87–92PubMedGoogle Scholar
  9. 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: 824–828PubMedGoogle Scholar
  10. 10.
    Cotton RE, Rideout DF (1964) Tears of the humeral rotator cuff. A radiological and pathological necropsy survey. J Bone Joint Surg Br 46: 314–328PubMedGoogle Scholar
  11. 11.
    Crass JR, Craig EV, Thompson R, Feinberg SB (1984) Ultrasonography of the rotator cuff: surgical correlation. J Clin Ultrasound 12: 487–492PubMedCrossRefGoogle Scholar
  12. 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): 186–193CrossRefGoogle Scholar
  13. 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: 1–166Google Scholar
  14. 14.
    Dorgan JA (1955) Posterior dislocation of the shoulder. Am J Surg 89(4): 890–900PubMedCrossRefGoogle Scholar
  15. 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: 118–122PubMedGoogle Scholar
  16. 16.
    Farin PU, Jaroma H (1995) Acute traumatic tears of the rotator cuff: value of sonography. Radiology 197(1): 269–273PubMedGoogle Scholar
  17. 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: 387–394CrossRefGoogle Scholar
  18. 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: 599–605PubMedCrossRefGoogle Scholar
  19. 19.
    Gazielly DF, Gleyze P, Montagnon C (1994) Functional and anatomical results after rotator cuff repair. Clin Orthop 304: 43–53PubMedGoogle Scholar
  20. 20.
    Ghelman B, Goldman AB (1977) The double contrast shoulder arthrogram: evaluation of rotator cuff tears. Radiology 124: 251–254PubMedGoogle Scholar
  21. 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): 126–127Google Scholar
  22. 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: 78–83PubMedGoogle Scholar
  23. 23.
    Harland U (1988) Die Abhängigkeit der Echogenität vom Anschallwinkel an Muskulatur und Sehnengewebe. Z Orthop 126: 117–124PubMedGoogle Scholar
  24. 24.
    Hedtmann A, Fett H (1988). Dynamische Ultraschalluntersuchung. In: Maaz B, Stahl C (Hrsg) Apparative Diagnostik des Schultergelenks. Thieme, Stuttgart, S 34–42Google Scholar
  25. 25.
    Hedtmann A, Fett H (1990) Schultersonographie. In: Hedtmann A (Hrsg) Degenerative Schultererkrankungen. Enke, Stuttgart, S 37–44Google Scholar
  26. 26.
    Hedtmann A, Fett H (1991) Atlas und Lehrbuch der Schultersonografie, 2. Aufl. Enke, StuttgartGoogle Scholar
  27. 27.
    Hedtmann A, Fett H (1995) Schultersonografie bei Subakromialsyndromen mit Erkrankungen und Verletzungen der Rotatorenmanschette. Orthopäde 24: 498–508PubMedGoogle Scholar
  28. 28.
    Hedtmann A, Weber A, Schleberger R, Fett H (1986) Ultraschalluntersuchung des Schultergelenks. Orthopädische Praxis 22: 647–661Google Scholar
  29. 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): 549–542CrossRefGoogle Scholar
  30. 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): 1296–1301PubMedGoogle Scholar
  31. 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: 152–160PubMedCrossRefGoogle Scholar
  32. 32.
    Hodler J, Fretz CJ, Terrier F, Gerber C (1988) Rotator cuff tears: correlation of sonographic and surgical findings. RadiologyGoogle Scholar
  33. 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: 431–436Google Scholar
  34. 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: 17–29PubMedGoogle Scholar
  35. 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: 1305–1311PubMedCrossRefGoogle Scholar
  36. 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: 161–173PubMedCrossRefGoogle Scholar
  37. 37.
    Katthagen BD (1988) Schultersonographie. Thieme, StuttgartGoogle Scholar
  38. 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): 371–378Google Scholar
  39. 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: 837–841PubMedGoogle Scholar
  40. 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: 242–246PubMedCrossRefGoogle Scholar
  41. 41.
    Kurol M, H Rahme, S Hilding (1991) Sonography for diagnosis of Rotator Cuff Tear. Acta Orthop Scand 62: 465–467PubMedCrossRefGoogle Scholar
  42. 42.
    Lindblom K, Palmer I (1938) Ruptures of the tendon aponeurosis of the shoulder joint –the so-called supraspinatus ruptures. Acta Chir Scand 82: 133–142Google Scholar
  43. 43.
    Mack LA, Matsen FA, Kilcoyne RF et al. (1985) Ultrasound evaluation of the rotator cuff. Radiology 157: 205PubMedGoogle Scholar
  44. 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: 21–27PubMedGoogle Scholar
  45. 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: 136–141PubMedCrossRefGoogle Scholar
  46. 46.
    Middleton WD, Edelstein G, Reinus WR et al. (1985) Sonographic detection of rotator cuff tears. AJR Am J Roentgenol 144(2): 349–53PubMedGoogle Scholar
  47. 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): 440–450PubMedGoogle Scholar
  48. 48.
    Misamore GW, Woodward C (1991) Evaluation of degenerative lesions of the rotator cuff. J Bone Joint Surg 73: 704–706PubMedGoogle Scholar
  49. 49.
    Müller T, Gohlke F, Kenn W (1996) Stellenwert der Magnetresonanztomographie. In: Eulert J, Hedtmann A (Hrsg.) Das Impingementsyndrom der Schulter. Thieme, StuttgartGoogle Scholar
  50. 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: 88Google Scholar
  51. 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: 707–716PubMedGoogle Scholar
  52. 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: 1281–1287PubMedGoogle Scholar
  53. 53.
    Newberg AH, Munn CS, Robbins AH (1985) Complications of arthrography. Radiology 157: 605–606Google Scholar
  54. 54.
    OberholzerJ (1933) Die Arthrosonographie bei habitueller Schulterluxation. Röntgenpraxis 5: 589–590Google Scholar
  55. 55.
    O’Connor PJ, Rankine J, Gibbon WW et al. (2005) Interobserver variation in sonography of the painful shoulder. Clin J Ultrasound 33(2): 53–56CrossRefGoogle Scholar
  56. 56.
    Olive RJ, HO Marsh (1992) Ultrasonography of rotator cuff tears. Clin Orthop 282: 110–113 PubMedGoogle Scholar
  57. 57.
    Palmer WE, Brown JH, Rosenthal DI (1993) Rotator cuff: evaluation with fat-suppressed MR arthrography. Radiology 188: 683–687PubMedGoogle Scholar
  58. 58.
    Pattee GA, Snyder St (1988) Sonographic evaluation of the rotator cuff: correlation with arthroscopy. Arthroscopy 4: 15–20PubMedCrossRefGoogle Scholar
  59. 59.
    Plafki C, Hedtmann A, Fett H et al. (1997) Ergebnisse der operativen Therapie von Rupturen der Rotatorenmanschette der Schulter. Z Orthop 135: 360–367PubMedGoogle Scholar
  60. 60.
    Preston BJ, Jackson JP (1977) Investigation of shoulder disability by arthrography. Clin Radiol 2: 259–266CrossRefGoogle Scholar
  61. 61.
    Rafii M, Firooznia H, Sherman O et al. (1990) Rotator cuff lesions: signal patterns at MR imaging. Radiology 177: 817–823PubMedGoogle Scholar
  62. 62.
    Rapf C, Furtschegger A, Resch H (1986) Die Sonographie als neues diagnostisches Verfahren zur Abklärung von Schulterbeschwerden. Fortschr Röntgenstr 145: 288–295CrossRefGoogle Scholar
  63. 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: 264–271PubMedCrossRefGoogle Scholar
  64. 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: 1451–1455Google Scholar
  65. 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 869–872Google Scholar
  66. 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): 223–227PubMedGoogle Scholar
  67. 67.
    van de Sande MA, Rozing PM (2006) Proximal migration can be measured accurately on standardized anteroposterior shoulder radiographs. Clin Orthop Relat Res 443: 260–265CrossRefGoogle Scholar
  68. 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 31–34Google Scholar
  69. 69.
    Seeger LL, Lubowitz J, Thomas BJ (1993) Case report 815: Tear of the rotator interval. Skeletal Radiol 22(8): 615–617PubMedCrossRefGoogle Scholar
  70. 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: 205–209PubMedCrossRefGoogle Scholar
  71. 71.
    Sperner G, Resch H, Golser K et al. (1993). Die Wertigkeit der Sonographie bei Rupturen der Rotatorenmanschette. Unfallchirurg 96: 119–123PubMedGoogle Scholar
  72. 72.
    Strobel K, Hodler J, Meyer DC et al. (2005) Fatty atrophy of supraspinatus and infraspinatus muscles: accuracy of US. Radiology 237(2): 584–589PubMedCrossRefGoogle Scholar
  73. 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: 2231–2238PubMedCrossRefGoogle Scholar
  74. 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: 484–504Google Scholar
  75. 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: 708–716PubMedGoogle Scholar
  76. 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: 264–268PubMedCrossRefGoogle Scholar
  77. 77.
    Thomazeau H, Boukobza E, Morcet N et al. (1997) Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop 344: 275–283PubMedGoogle Scholar
  78. 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: 109–114PubMedGoogle Scholar
  79. 79.
    Torstensen ET, Hollinshead RM (1999) Comparison of magnetic resonance imaging and arthroscopy in the evaluation of shoulder pathology. J Shoulder Elbow Surg 8: 42–45PubMedCrossRefGoogle Scholar
  80. 80.
    Tyson LL, Crues JV (1993) Pathogenesis of rotator cuff disorders. Magnetic resonance imaging characteristics. Magn Reson Imaging Clin North Am 1: 37–46Google Scholar
  81. 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: 223–227PubMedCrossRefGoogle Scholar
  82. 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: 443–446Google Scholar
  83. 83.
    Vick CW, Bell SA (1990) Rotator cuff tears: Diagnosis with sonography. AJR Am J Roentgenol 154: 121–123PubMedGoogle Scholar
  84. 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: 463–469PubMedCrossRefGoogle Scholar
  85. 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: 103–107Google Scholar
  86. 86.
    Wijnbladh H (1933) Zur Röntgendiagnose von Schulterluxationen. Chirurg 5: 702Google Scholar
  87. 87.
    Wülker N, Melzer C, Wirth CJ (1991) Shoulder surgery for rotator cuff tears. Acta Orthop Scand 62: 142–147PubMedCrossRefGoogle Scholar
  88. 88.
    Wülker N, Roetmann B, Schmitzer H, Roessig S (1995) Coracoacromial pressure recordings in an expermental shoulder model. J Shoulder Elbow Surg 4: 462–467CrossRefGoogle Scholar
  89. 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): 493–506PubMedGoogle Scholar
  90. 90.
    Zanetti M, Gerber C, Hodler J (1998) Quantitative assessment of the muscles of the rotator cuff with MR imaging. Invest. Radiol 33: 163–170Google Scholar
  91. 91.
    Zanetti M, Jost B, Lustenberger A, Hodler J (1999) Clinical impact of MR arthrography of the shoulder. Acta Radiol. 40: 296–302Google Scholar
  92. 92.
    Zlatkin MB, Dalinka MK, Kressel HY (1989) Magnetic resonance imaging of the shoulder. [Review] Magn Reson Q 5: 3–22Google Scholar
  93. 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): 78Google Scholar

Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Orthopädische Abteilung Klinik Fleetinsel HamburgHamburgDeutschland

Personalised recommendations