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Skeletal Radiology

, Volume 36, Issue 9, pp 841–845 | Cite as

Muscle atrophy as a consequence of rotator cuff tears: should we compare the muscles of the rotator cuff with those of the deltoid?

  • Reem AshryEmail author
  • Mark E. Schweitzer
  • Patricia Cunningham
  • Jodi Cohen
  • James Babb
  • Andrew Cantos
Scientific Article

Abstract

Purpose

The quantitative assessment of muscle atrophy has a degree of importance in prognosticating rotator cuff treatment. However, it has been conjectured that muscle fat increases with aging. Therefore, we thought that the quantitative assessment of the supraspinatous would be better if made in comparison with a standard of reference such as the deltoid. Consequently, we performed a two-part study, first evaluating supraspinatous changes compared with the deltoid in “normals” with aging, and second, determining if in patients with cuff tears the supraspinatous fat exceeds that of the deltoid.

Materials and methods

In part 1, we studied 50 patients stratified by decade. In the first sitting, two blinded independent observers quantitatively graded the deltoid (with the supraspinatous obscured) and in the second sitting the same two observers quantitatively graded the supraspinatous (with the deltoid obscured). In part 2 of the study, we evaluated patients with moderate rotator cuff tears (>2 cm) and performed the same blinded, two-sitting, quantitative assessment (with the comparison muscle obscured).

Results

We found that muscle atrophy increases with age in patients without tears (0.011/0.028 U/year), although to a greater degree in the deltoid (p = 0.032). Also, in similarly aged patients, quantitative scores of the deltoid closely matched those of the supraspinatous (p = 0.071). Notably, however, in patients with large tears, the supraspinatous showed significant changes disproportionate to those of the deltoid, regardless of patient age (p = 0.044).

Conclusion

In the presence of a normal rotator cuff, fatty infiltration increases with age. Age-related changes occur more frequently in the deltoid, verifying this muscle’s potential as a standard of reference. With cuff tears, supraspinatous atrophy was disproportionate to that of the deltoid. Therefore, systematic assessment of supraspinatous muscle atrophy may be more reliable using the deltoid as a control for comparison than assessing it in isolation.

Keywords

MRI shoulder Muscle atrophy Rotator cuff tear 

References

  1. 1.
    Strobel K, Hodler J, Meyer DC, et al. Fatty atrophy of supraspinatous and infraspinatus muscles: accuracy of US. Radiology 2005; 237(2): 584–589.PubMedCrossRefGoogle Scholar
  2. 2.
    Nakagaki K, Ozaki J, Tomita Y, et al. Fatty degeneration in the supraspinatus muscle after rotator cuff tear. J Shoulder Elbow Surg 1996; 5(3): 194–200.PubMedCrossRefGoogle Scholar
  3. 3.
    Meyer DC, Pirkl C, Pfirrmann CW, et al. Asymmetric atrophy of the supraspinatus muscle following tendon tear. J Orthop Res 2005; 23(2): 254–258.PubMedCrossRefGoogle Scholar
  4. 4.
    Goutallier D, Postel JM, Gleyze P, et al. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg 2003; 12(6): 550–554.PubMedCrossRefGoogle Scholar
  5. 5.
    Harryman DT, Mack LA, Wang KY, et al. Repairs of the rotator cuff: correlation of functional results with integrity of the cuff. J Bone Joint Surg Am 1991; 73: 982–989.PubMedGoogle Scholar
  6. 6.
    Goutallier D, Bernageau J, Patte D. Assessment of the trophicity of the muscles of the ruptured rotator cuff by CT. In: Past M, Morrey BF, Hawkins RJ, eds. Surgery of the shoulder. St. Louis: Mosby Year Book; 1990. pp 11–30.Google Scholar
  7. 7.
    Tingart MJ, Apreleva M, Lehtinen JT. Magnetic resonance imaging in quantitative analysis of rotator cuff muscle volume. Clin Orthop Relat Res 2003; 415: 104–110.PubMedCrossRefGoogle Scholar
  8. 8.
    Van de Sande M, Stoel BC, Obermann WR, et al. Quantitative assessment of fatty degeneration in rotator cuff muscles determined with computed tomography. Invest Radiol 2005; 40(5): 313–319.PubMedCrossRefGoogle Scholar
  9. 9.
    Bastard JP, Maachi M, Lagathu C, et al. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw 2006; 17(1): 4–12.PubMedGoogle Scholar
  10. 10.
    Jost B, Zumstein M, Pfirrmann CW, et al. Long-term outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am 2006; 88(3): 472–479.PubMedCrossRefGoogle Scholar
  11. 11.
    Morag Y, Jacobson JA, Miller B, et al. MR imaging of rotator cuff injury: what the clinician needs to know. Radiographics 2006; 26(4): 1045–1065.PubMedCrossRefGoogle Scholar
  12. 12.
    Davidson JF, Burkhart SS, Richards DP, et al. Use of preoperative magnetic resonance imaging to predict rotator cuff tear pattern and method of repair. Arthroscopy 2005; 21(12): 1428.PubMedGoogle Scholar
  13. 13.
    Moosikasuwan JB, Miller TT, Burke BJ. Rotator cuff tears: clinical, radiographic, and US findings. Radiographics 2005; 25(6): 1591–1607.PubMedCrossRefGoogle Scholar
  14. 14.
    Kneeland JB, Middleton WD, Carrera GF, et al. MR imaging of the shoulder: diagnosis of rotator cuff tears. AJR Am J Roentgenol 1987; 149(2): 333–337.PubMedGoogle Scholar
  15. 15.
    Euancho AM, Stiles RG, Fajman WA, et al. MR imaging diagnosis of rotator cuff tears. AJR Am J Roentgenol 1988; 151(4): 741–744.Google Scholar
  16. 16.
    Farley TE, Neuman CH, Steinbach LS, Jahnke AJ, Petersen SS. Full-thickness tears of the rotator cuff of the shoulder: diagnosis with MR imaging. AJR Am J Roentgenol 1992; 158(2): 347–351.PubMedGoogle Scholar
  17. 17.
    Teefey SA, Rubin DA, Middleton WD, et al. 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 2004; 86(4): 708–716.PubMedGoogle Scholar
  18. 18.
    Mercuri E, Bushby K, Ricci E, et al. Muscle MRI findings in patients with limb girdle muscular dystrophy with calpain 3 deficiency (LGMD2A) and early contractures. Neuromuscul Disord 2005; 15(2): 164–171.PubMedCrossRefGoogle Scholar
  19. 19.
    Abou Salem EA, Ishikawa H. Early morphological changes in the rat soleus muscle induced by tenotomy and denervation. J Electron Microsc (Tokyo) 2001; 50(3): 275–282.CrossRefGoogle Scholar
  20. 20.
    Reimers CD, Fleckenstein JL, Witt TN, et al. Muscular ultrasound in idiopathic inflammatory myopathies of adults. J Neurol Sci 1993; 116(1): 82–92.PubMedCrossRefGoogle Scholar
  21. 21.
    Kenn W, Bohm D, Gohlke F, et al. 2D SPLASH: a new method to determine the fatty infiltration of the rotator cuff muscles. Eur Radiol 2004; 14(12): 2331–2336.PubMedCrossRefGoogle Scholar
  22. 22.
    Lecker SH, Jagoe RT, Gilbert A, et al. Multiple types of skeletal muscle atrophy involve a common program of changes in gene expression. FASEB J 2004; 18(1): 39–51.PubMedCrossRefGoogle Scholar
  23. 23.
    Goutallier D, Postel JM, Bernageau J, et al. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 1994; 304: 78–83.PubMedGoogle Scholar
  24. 24.
    Goutallier D, Postel JM, Van Driessche S, et al. Histological lesions of supraspinatus tendons in full thickness tears of the rotator cuff. Invest Radiol 2005; 40(5): 313–319.CrossRefGoogle Scholar
  25. 25.
    Thomazeau H, Boukobza E, Morcet N, et al. Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res 1997; 344: 275–283.PubMedCrossRefGoogle Scholar
  26. 26.
    Pfirrmann CW, Schmid MR, Zanetti M, et al. Assessment of fat content in supraspinatus muscle with proton MR spectroscopy in asymptomatic volunteers and patients with supraspinatus tendon lesions. Radiology 2004; 232(3): 709–715.PubMedCrossRefGoogle Scholar
  27. 27.
    Fuchs B, Weishaupt D, Zanetti M, et al. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 1999; 8(6): 599–605.PubMedCrossRefGoogle Scholar
  28. 28.
    Mellado JM, Calmet J, Olona M, et al. Surgically repaired massive rotator cuff tears: MRI of tendon integrity, muscle fatty degeneration, and muscle atrophy correlated with intraoperative and clinical findings. AJR Am J Roentgenol 2005; 184(5): 1456–1463.PubMedGoogle Scholar

Copyright information

© ISS 2007

Authors and Affiliations

  • Reem Ashry
    • 1
    Email author
  • Mark E. Schweitzer
    • 1
  • Patricia Cunningham
    • 1
  • Jodi Cohen
    • 1
  • James Babb
    • 1
  • Andrew Cantos
    • 1
  1. 1.Department of RadiologyHospital for Joint Diseases, NYU Medical CenterNew YorkUSA

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