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Supraspinatus pathology on MRI is associated with degree of weakness on dynamic clinical strength testing

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Abstract

Objective

To analyze shoulder strength and function in patients presenting with possible supraspinatus pathology and to ascertain if these clinical findings are associated with severity of supraspinatus pathology on MRI.

Materials and methods

In total, 171 patients with presumptive rotator cuff pathology and with preserved strength on standard rotator cuff examination were prospectively recruited. Patients were subjected to bilateral shoulder strength testing employing dynamometry; this included isometric strength testing at 90° of abduction, followed by eccentric assessment of isotonic strength from full abduction through the full range of motion until the arm rested at the patient’s side. We calculated absolute strength and symptomatic-to-asymptomatic arm (S/A) strength ratios. On subsequent shoulder MRI, supraspinatus pathology was designated into one of seven categories. The association between strength measurements and MRI findings was analyzed.

Results

Increasing lesion severity on MRI was associated with both decreasing absolute strength (no tear [59.9 N] to full-thickness tear [44.2 N]; P = 0.036) and decreasing S/A strength ratios during isotonic testing (no tear [91.9%] to full-thickness tear [65.3%]; P = 0.022). In contrast, there were no significant relationships between imaging severity and absolute strength or S/A strength ratios on isometric testing.

Conclusion

Severity of supraspinatus pathology on MRI was associated with dynamic clinical function. These results validate the clinical correlation between MRI designations of supraspinatus pathology and function and suggest the need for future work to investigate utility of dynamic (versus isometric) rotator cuff physical examination maneuvers.

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References

  1. Picavet HSJ, Schouten JSAG. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain. 2003;102:167–78.

    Article  CAS  Google Scholar 

  2. Rekola KE, Keinanen-Kiukaanniemi S, Takala J. Use of primary health services in sparsely populated country districts by patients with musculoskeletal symptoms: consultations with a physician. J Epidemiol Community Health. 1993;47:153–7.

    Article  CAS  Google Scholar 

  3. Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis. 1998;57:649–55.

    Article  CAS  Google Scholar 

  4. Chard MD, Hazleman R, Hazelman B, King RH, Reiss BB. Shoulder disorders in the elderly: a community survey. Arthritis Rhum. 1991;34:766–9.

    Article  CAS  Google Scholar 

  5. 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  Google Scholar 

  6. Iagnocco A, Coari G, Leone A, Valesini G. Sonographic study of painful shoulder. Clin Exp Rheumatol. 2003;21:355–8.

    CAS  PubMed  Google Scholar 

  7. Kim HA, Kim SH, Seo YI. Ultrasonographic findings of painful shoulders and correlation between physical examination and ultrasonographic rotator cuff tear. Mod Rheumatol. 2007;17:213–9.

    Article  Google Scholar 

  8. Jain NB, Ayers GD, Fan R, Kuhn JE, Warner JJP, Baumgarten KM, et al. Comparative effectiveness of operative versus nonoperative treatment for rotator cuff tears: a propensity score analysis from the ROW cohort. Am J Sports Med. 2019;47:3065–72.

    Article  Google Scholar 

  9. Piper CC, Hughes AJ, Ma Y, Wang H, Neviaser AS. Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elb Surg. 2018;27:572–6.

    Article  Google Scholar 

  10. Cho CH, Song KS, Hwang I, Warner JJP. Does rotator cuff repair improve psychologic status and quality of life in patients with rotator cuff tear? Clin Orthop Relat Res. 2015;473:3494–3500.

    Article  Google Scholar 

  11. Mall NA, Kim HM, Keener JD, Steger-May K, Teefey SA, Middleton WD, et al. Symptomatic progression of asymptomatic rotator cuff tears a prospective study of clinical and sonographic variables. J Bone Jt Surg - Ser A. 2010;92:2623–33.

    Article  Google Scholar 

  12. Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med. 2012;31:589–604.

    Article  Google Scholar 

  13. Tawfik AM. Rotator cuff disorders: how to write a surgically relevant magnetic resonance imaging report? World J Radiol. 2014;6:274.

    Article  Google Scholar 

  14. Morag Y, Jacobson JA, Miller B, De Maeseneer M, Girish G, Jamadar D. MR imaging of rotator cuff injury: what the clinician needs to know. Radiographics. 2006;26:1045–65.

    Article  Google Scholar 

  15. Tuna S, Balcı N. The relationship between radiological severity and functional status in patients with knee osteoarthritis. Clin Rheumatol. 2014;33:667–670.

    Article  Google Scholar 

  16. Abraham PF, Nazal MR, Varady NH, Gillinov SM, Quinlan NJ, Alpaugh K, et al. The new dynamic isotonic manipulation examination (DIME) is a highly sensitive secondary screening tool for supraspinatus full-thickness tears. J Shoulder Elb Surg. 2020;29:2213–20.

    Article  Google Scholar 

  17. Johansson FR, Skillgate E, Lapauw ML, Clijmans D, Deneulin VP, Palmans T, et al. Measuring eccentric strength of the shoulder external rotators using a handheld dynamometer: Reliability and validity. J Athl Train. 2015;50:719–25.

    Article  Google Scholar 

  18. Hayes K, Walton JR, Szomor ZL, Murrell GAC. Reliability of 3 methods for assessing shoulder strength. J Shoulder Elb Surg. 2002;11:33–9.

    Article  Google Scholar 

  19. MacDermid JC, Ramos J, Drosdowech D, Faber K, Patterson S. The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life. J Shoulder Elb Surg. 2004;13:593–8.

    Article  Google Scholar 

  20. Leggin BG, Neuman RM, Iannotti JP, Williams GR, Thompson EC. Intrarater and interrater reliability of three isometric dynamometers in assessing shoulder strength. J Shoulder Elbow Surg. 1996;5:18–24.

    Article  CAS  Google Scholar 

  21. Jain NB, Wilcox RB III, Katz JN, Higgins LD. Clinical examination of the rotator cuff. PM&R. 2013;5:45–56.

    Article  Google Scholar 

  22. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med [Internet]. 2016;15:155–63.

    Article  Google Scholar 

  23. Al-Amiry BS, Gaber JF, Kadum BK, Brismar TB, Sayed-Noor AS. The influence of radiological severity and symptom duration of osteoarthritis on postoperative outcome after total hip arthroplasty: a prospective cohort study. J Arthroplasty. 2018;33:436–40. 

    Article  Google Scholar 

  24. Alpert SW, Pink MM, Jobe FW, Mcmahon PJ. EMG analysis of deltoid and rotator cuff fucntion under varying loads and speeds. J Shoulder Elb Surg. 2000;9:47–58.

    Article  CAS  Google Scholar 

  25. Chalmers PN, Cvetanovich GL, Kupfer N, Wimmer MA, Verma NN, Cole BJ, et al. The champagne toast position isolates the supraspinatus better than the Jobe test: An electromyographic study of shoulder physical examination tests. J Shoulder Elb Surg. 2016;25:322–9.

    Article  Google Scholar 

  26. Ruckstuhl H, Krzycki J, Petrou N, Favre P, Horn T, Schmid S, et al. Shoulder abduction moment arms in three clinically important positions. J Shoulder Elb Surg. 2009;18:632–8.

    Article  Google Scholar 

  27. Reddy AS, Mohr KJ, Pink MM, Jobe FW. Electromyographic analysis of the deltoid and rotator cuff muscles in persons with subacromial impingement. J Shoulder Elb Surg. 2000;9:519–23.

    Article  CAS  Google Scholar 

  28. Hawkes DH, Alizadehkhaiyat O, Fisher AC, Kemp GJ, Roebuck MM, Frostick SP. Normal shoulder muscular activation and co-ordination during a shoulder elevation task based on activities of daily living: an electromyographic study. J Orthop Res. 2012;30:53–60.

    Article  Google Scholar 

  29. Brox JI, Gjengedal E, Uppheim G, Bøhmer AS, Brevik JI, Ljunggren AE, Staff PH. Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome):a prospective, randomized, controlled study in 125 patients with a 2 1/2-year follow-up. J Shoulder Elb Surg. 1999;8:102–11.

    Article  CAS  Google Scholar 

  30. Morrison DS, Frogameni AD, Woodworth P. Non-operative treatment of subacromial impingement syndrome. J Bone Jt Surg - Ser A. 1997;79:732–7.

    Article  CAS  Google Scholar 

  31. Tashjian RZ. Is there Evidence in favor of surgical interventions for the subacromial impingement syndrome? Clin J Sport Med. 2013;23:406–7.

    Article  Google Scholar 

  32. Toliopoulos P, Desmeules F, Boudreault J, Roy JS, Frémont P, MacDermid JC, et al. Efficacy of surgery for rotator cuff tendinopathy: a systematic review. Clin Rheumatol. 2014;33:1373–83.

    Article  Google Scholar 

  33. Lewis J, Mccreesh K, Roy JS, Ginn K. Rotator cuff tendinopathy: Navigating the diagnosis-management conundrum. J Orthop Sports Phys Ther. 2015;45:923–37.

    Article  Google Scholar 

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Acknowledgements

Conine Family Fund for Joint Preservation.

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Authors and Affiliations

  1. Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA

    Stephen M. Gillinov, Wendy M. Meek, Christopher T. Eberlin & Scott D. Martin

  2. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Nathan H. Varady

  3. Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA

    Paul F. Abraham

  4. Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Kirstin M. Small

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  1. Stephen M. Gillinov
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Correspondence to Stephen M. Gillinov.

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Conflict of interest

Stephen M. Gillinov, AB has no conflict of interest. Nathan H. Varady, MD/MBA has no conflict of interest. Paul F. Abraham, MD has no conflict of interest. Wendy M. Meek, BBA has no conflict of interest. Christopher T. Eberlin, BS has no conflict of interest. Kirstin M. Small, MD has received research support from Pfizer. Scott D. Martin, MD has received education payments from Kairos Surgical and honoraria from Allergan.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Stephen M. Gillinov and Nathan H. Varady are co-first authors and contributed equally to the work.

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Gillinov, S.M., Varady, N.H., Abraham, P.F. et al. Supraspinatus pathology on MRI is associated with degree of weakness on dynamic clinical strength testing. Skeletal Radiol 51, 1967–1974 (2022). https://doi.org/10.1007/s00256-022-04049-x

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  • DOI: https://doi.org/10.1007/s00256-022-04049-x

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