Skip to main content

Advertisement

Log in

Subacromial impingement anatomy and its association with rotator cuff pathology in women: radiograph and MRI correlation, a retrospective evaluation

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the relationships between acromial anatomy and developmental alterations with rotator cuff tears in female patients and compare these parameters on radiographs and corresponding MRIs along with inter-reader performance.

Materials and methods

Patient demographics, symptoms, and acromial characteristics on radiograph (acromial index, lateral acromion angle, subacromial space on AP and Y- views, acromial anterior and lateral downsloping) and MRI (shape, slope, spur, osteoarthrosis, os acromiale) were recorded. Radiographic and MRI findings were compared and correlated with rotator cuff pathology on MRI. Inter-reader analysis was performed.

Results

A total of 140 MRIs from 137 female patients were included. No significant correlation (p > 0.05) existed between acromial parameters and rotator cuff tears, except for a smaller subacromial space on the Y view and spurs correlated with subscapularis tendon tear (p = 0.02, p = 0.04). The presence of lateral downsloping on MRI correlated with a smaller lateral acromion angle (p = 0.0002) and the presence of lateral downsloping on radiography (p = 0.0015). Inter-reader agreements were good to excellent (ICC: 0.65–0.89).

Conclusion

Subacromial impingement anatomy characteristics have no significant associations with supraspinatus or infraspinatus tears in symptomatic women. Among different measures, supine MRI can be reliably used to identify lateral downsloping of the acromion.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Oh LS, Wolf BR, Hall MP, Levy BA, Marx RG. Indications for rotator cuff repair: a systematic review. Clin Orthop Relat Res. 2007;455:52–63.

    Article  PubMed  Google Scholar 

  2. Mather RC 3rd, Koenig L, Acevedo D, et al. The societal and economic value of rotator cuff repair. J Bone Joint Surg Am. 2013;95(22):1993–2000.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Codman EA, Akerson IB. The pathology associated with rupture of the supraspinatus tendon. Ann Surg. 1931;93(1):348–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972;54(1):41–50.

    Article  PubMed  Google Scholar 

  5. Biberthaler P, Wiedemann E, Nerlich A, et al. Microcirculation associated with degenerative rotator cuff lesions. In vivo assessment with orthogonal polarization spectral imaging during arthroscopy of the shoulder. J Bone Joint Surg Am. 2003;85-A(3):475–80.

    Article  Google Scholar 

  6. Kumagai J, Sarkar K, Uhthoff HK. The collagen types in the attachment zone of rotator cuff tendons in the elderly: an immunohistochemical study. J Rheumatol. 1994;21(11):2096–100.

    CAS  PubMed  Google Scholar 

  7. Oh JH, Kim JY, Lee HK, Choi JA. Classification and clinical significance of acromial spur in rotator cuff tear: heel-type spur and rotator cuff tear. Clin Orthop Relat Res. 2010;468(6):1542–50.

    Article  PubMed  Google Scholar 

  8. Hamid N, Omid R, Yamaguchi K, Steger-May K, Stobbs G, Keener JD. Relationship of radiographic acromial characteristics and rotator cuff disease: a prospective investigation of clinical, radiographic, and sonographic findings. J Shoulder Elbow Surg. 2012;21(10):1289–98.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bigliani LU, , Ticker JB, Flatow EL, Soslowsky LJ, Mow VC. The relationship of acromial architecture to rotator cuff disease. Clin Sports Med. 1991;10(4):823–38.

    CAS  PubMed  Google Scholar 

  10. Nyffeler RW, Werner CM, Sukthankar A, Schmid MR, Gerber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. 2006;88(4):800–5.

    PubMed  Google Scholar 

  11. Balke M, Schmidt C, Dedy N, Banerjee M, Bouillon B, Liem D. Correlation of acromial morphology with impingement syndrome and rotator cuff tears. Acta Orthop. 2013;84(2):178–83.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Banas MP, Miller RJ, Totterman S. Relationship between the lateral acromion angle and rotator cuff disease. J Shoulder Elbow Surg. 1995;4(6):454–61.

    Article  CAS  PubMed  Google Scholar 

  13. Moor BK, Wieser K, Slankamenac K, Gerber C, Bouaicha S. Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elbow Surg. 2014;23(4):536–41.

    Article  PubMed  Google Scholar 

  14. Elert J, Sterner Y, Nyberg V, Gerdle B. Lack of gender differences in the ability to relax between repetitive maximum isokinetic shoulder forward flexions: a population-based study among northern Swedes. Eur J Appl Physiol. 2000;83(4–5):246–56.

    Article  CAS  PubMed  Google Scholar 

  15. White JJ, Titchener AG, Fakis A, Tambe AA, Hubbard RB, Clark DI. An epidemiological study of rotator cuff pathology using the health improvement network database. Bone Joint J. 2014;96-B(3):350–3.

    Article  CAS  PubMed  Google Scholar 

  16. Razmjou H, Davis AM, Jaglal SB, Holtby R, Richards RR. Disability and satisfaction after rotator cuff decompression or repair: a sex and gender analysis. BMC Musculoskelet Disord. 2011;12:66.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cho CH, Ye HU, Jung JW, Lee YK. Gender affects early postoperative outcomes of rotator cuff repair. Clin Orthop Surg. 2015;7(2):234–40.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hamada K, Yamanaka K, Uchiyama Y, Mikasa T, Mikasa M. A radiographic classification of massive rotator cuff tear arthritis. Clin Orthop Relat Res. 2011;469(9):2452–60.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gyftopoulos S, Guja KE, Subhas N, Virk MS, Gold HT. Cost-effectiveness of magnetic resonance imaging versus ultrasound for the detection of symptomatic full-thickness supraspinatus tendon tears. J Shoulder Elbow Surg. 2017;26(12):2067–77.

    Article  PubMed  Google Scholar 

  20. Yablon CM, Bedi A, Morag Y, Jacobson JA. Ultrasonography of the shoulder with arthroscopic correlation. Clin Sports Med. 2013;32(3):391–408.

    Article  PubMed  Google Scholar 

  21. Tucker TJ, Snyder SJ. The keeled acromion: an aggressive acromial variant--a series of 20 patients with associated rotator cuff tears. Arthroscopy. 2004;20(7):744–53.

    Article  PubMed  Google Scholar 

  22. Soldatos ACT. Musculoskeletal MRI structured evaluation: how to practically fill the reporting checklist. Philadelphia: Wolters Kluwer Health; 2015.

    Google Scholar 

  23. Vitale MA, Arons RR, Hurwitz S, Ahmad CS, Levine WN. The rising incidence of acromioplasty. J Bone Joint Surg Am. 2010;92(9):1842–50.

    Article  PubMed  Google Scholar 

  24. Miyazaki AN, Fregoneze M, Santos PD, et al. Radiographic study on the acromion index and its relationship with rotator cuff tears. Rev Bras Ortop. 2010;45(2):151–4.

    Article  PubMed  Google Scholar 

  25. Melean P, Lichtenberg S, Montoya F, Riedmann S, Magosch P, Habermeyer P. The acromial index is not predictive for failed rotator cuff repair. Int Orthop. 2013;37(11):2173–9.

  26. Viskontas DG, MacDermid JC, Drosdowech DS, Garvin GJ, Romano WM, Faber KJ. Reliability and comparison of acromion assessment techniques on X-ray and magnetic resonance imaging (reliability of acromion assessment techniques). Can Assoc Radiol J. 2005;56(4):238–44.

    PubMed  Google Scholar 

  27. Moses DA, Chang EY, Schweitzer ME. The scapuloacromial angle: a 3D analysis of acromial slope and its relationship with shoulder impingement. J Magn Reson Imaging. 2006;24(6):1371–7.

    Article  PubMed  Google Scholar 

  28. Aoki M, Ishii S, Usui M, Mizuguchi M, Miyano S. The slope of the acromion and rotator cuff impingement. Orthop Trans. 1986;10:228.

    Google Scholar 

  29. Zuckerman JD, Kummer FJ, Cuomo F, Simon J, Rosenblum S, Katz N. The influence of coracoacromial arch anatomy on rotator cuff tears. J Shoulder Elbow Surg. 1992;1(1):4–14.

    Article  CAS  PubMed  Google Scholar 

  30. Kitay GS, Iannotti JP, Williams GR, Haygood T, Kneeland BJ, Berlin J. Roentgenographic assessment of acromial morphologic condition in rotator cuff impingement syndrome. J Shoulder Elbow Surg. 1995;4(6):441–8.

    Article  CAS  PubMed  Google Scholar 

  31. Pandey V, Vijayan D, Tapashetti S, et al. Does scapular morphology affect the integrity of the rotator cuff? J Shoulder Elbow Surg. 2016;25(3):413–21.

    Article  PubMed  Google Scholar 

  32. Zuckerman JD, Kummer FJ, Cuomo F, Greller M. Interobserver reliability of acromial morphology classification: an anatomic study. J Shoulder Elbow Surg. 1997;6(3):286–7.

  33. Petersson CJ, Redlund-Johnell I. The subacromial space in normal shoulder radiographs. Acta Orthop Scand. 1984;55(1):57–8.

    Article  CAS  PubMed  Google Scholar 

  34. Navarro-Ledesma S, Luque-Suarez A. Comparison of acromiohumeral distance in symptomatic and asymptomatic patient shoulders and those of healthy controls. Clin Biomech (Bristol, Avon). 2018;53:101–6.

    Article  CAS  Google Scholar 

  35. Beard DJ, Rees JL, Cook JA, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet. 2018;391(10118):329–38.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ketola S, Lehtinen JT, Arnala I. Arthroscopic decompression not recommended in the treatment of rotator cuff tendinopathy: a final review of a randomised controlled trial at a minimum follow-up of ten years. Bone Joint J. 2017;99-B(6):799–805.

    Article  CAS  PubMed  Google Scholar 

  37. Kolk A, Thomassen BJW, Hund H, et al. Does acromioplasty result in favorable clinical and radiologic outcomes in the management of chronic subacromial pain syndrome? A double-blinded randomized clinical trial with 9 to 14 years’ follow-up. J Shoulder Elbow Surg. 2017;26(8):1407–15.

    Article  PubMed  Google Scholar 

  38. Giaroli EL, Major NM, Lemley DE, Lee J. Coracohumeral interval imaging in subcoracoid impingement syndrome on MRI. AJR Am J Roentgenol. 2006;186(1):242–6.

    Article  PubMed  Google Scholar 

  39. Kay SP, Dragoo JL, Lee R. Long-term results of arthroscopic resection of the distal clavicle with concomitant subacromial decompression. Arthroscopy. 2003;19(8):805–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Chayanit Sasiponganan.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sasiponganan, C., Dessouky, R., Ashikyan, O. et al. Subacromial impingement anatomy and its association with rotator cuff pathology in women: radiograph and MRI correlation, a retrospective evaluation. Skeletal Radiol 48, 781–790 (2019). https://doi.org/10.1007/s00256-018-3096-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-018-3096-0

Keywords

Navigation