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Zhang G, Hu Q, Zhang J, Ying L, Hang D, Zhou X, Zhang Q. A new section of shoulder magnetic resonance imaging (MRI) used to assess the fat infiltration of the rotator cuff muscles. J Orthop Surg Res 2025; 20:433. [PMID: 40301927 PMCID: PMC12042595 DOI: 10.1186/s13018-025-05832-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Accepted: 04/20/2025] [Indexed: 05/01/2025] Open
Abstract
BACKGROUND Accurately assessing the degree of fat infiltration in the rotator cuff muscles is essential. However, in patients with massive rotator cuff tears and significant retractions, assessing fat infiltration of the rotator cuff in the traditional scapular Y-view of Shoulder MRI is not very accurate. PURPOSE This study aimed to evaluate the reliability and reproducibility of the suprascapular notch sagittal section (r-view) for assessing fatty infiltration in the supraspinatus and infraspinatus muscles, with comparative analysis against the Y-view assessment results. METHODS Magnetic resonance imaging data from 91 patients with rotator cuff tears (RTCs) were retrospectively analyzed. The patients were divided into three groups on the basis of the extent of retraction of rotator cuff tears. Fat infiltration of rotator cuff muscles was independently graded by three orthopedic surgeons via the Goutallier classification. The interclass and intraclass correlation coefficients (ICCs) were calculated to assess the consistency and repeatability of grading fat infiltration in the supraspinatus and infraspinatus using Y view and r view. The Wilcoxon rank-sum test was used to compare categorical variables of 3 groups (fat infiltration of the supraspinatus and infraspinatus graded in Y view and r view). RESULTS In the 3 groups of patients, regardless of the supraspinatus or the infraspinatus, the interclass coefficients of fat infiltration grade in the r view were ≥ 0.80, with excellent interobserver agreement and reliability of evaluation. The intraclass coefficients of each reader for grading fat infiltration of the supraspinatus and infraspinatus in the r view were ≥ 0.80, indicating excellent intraobserver agreement and reproducibility. In the group with the most severe rotator cuff tear retraction, there was a significant difference in the degree of fat infiltration between Y view and r view (P < 0.01). CONCLUSION The r view utilized in this study is a new section for assessing the fat infiltration of the supraspinatus and infraspinatus. In contrast to the conventional Y view, assessing fatty infiltration of the supraspinatus and infraspinatus muscles in the r view demonstrates better reliability and reproducibility, with less influence from tendon retraction. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Guoyin Zhang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No.150 Ximen Street, Linhai City, Zhejiang, China
| | - Qi Hu
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No.150 Ximen Street, Linhai City, Zhejiang, China
| | - Jianmin Zhang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No.150 Ximen Street, Linhai City, Zhejiang, China
| | - Li Ying
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No.150 Ximen Street, Linhai City, Zhejiang, China
| | - Dawei Hang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No.150 Ximen Street, Linhai City, Zhejiang, China
| | - Xiaobo Zhou
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No.150 Ximen Street, Linhai City, Zhejiang, China.
| | - Qingguo Zhang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No.150 Ximen Street, Linhai City, Zhejiang, China.
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Lee SH, Lee J, Oh KS, Yoon JP, Seo A, Jeong Y, Chung SW. Automated 3-dimensional MRI segmentation for the posterosuperior rotator cuff tear lesion using deep learning algorithm. PLoS One 2023; 18:e0284111. [PMID: 37200275 DOI: 10.1371/journal.pone.0284111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/23/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Rotator cuff tear (RCT) is a challenging and common musculoskeletal disease. Magnetic resonance imaging (MRI) is a commonly used diagnostic modality for RCT, but the interpretation of the results is tedious and has some reliability issues. In this study, we aimed to evaluate the accuracy and efficacy of the 3-dimensional (3D) MRI segmentation for RCT using a deep learning algorithm. METHODS A 3D U-Net convolutional neural network (CNN) was developed to detect, segment, and visualize RCT lesions in 3D, using MRI data from 303 patients with RCTs. The RCT lesions were labeled by two shoulder specialists in the entire MR image using in-house developed software. The MRI-based 3D U-Net CNN was trained after the augmentation of a training dataset and tested using randomly selected test data (training: validation: test data ratio was 6:2:2). The segmented RCT lesion was visualized in a three-dimensional reconstructed image, and the performance of the 3D U-Net CNN was evaluated using the Dice coefficient, sensitivity, specificity, precision, F1-score, and Youden index. RESULTS A deep learning algorithm using a 3D U-Net CNN successfully detected, segmented, and visualized the area of RCT in 3D. The model's performance reached a 94.3% of Dice coefficient score, 97.1% of sensitivity, 95.0% of specificity, 84.9% of precision, 90.5% of F1-score, and Youden index of 91.8%. CONCLUSION The proposed model for 3D segmentation of RCT lesions using MRI data showed overall high accuracy and successful 3D visualization. Further studies are necessary to determine the feasibility of its clinical application and whether its use could improve care and outcomes.
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Affiliation(s)
- Su Hyun Lee
- Department of Orthopaedic Surgery, Seoul Red Cross Hospital, Seoul, Korea
| | - JiHwan Lee
- Department of Orthopedic Surgery, Myongji Hospital, Goyang-si, Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University College of Medicine, Daegu, Korea
| | - Anna Seo
- SEEANN Solution, Yeonsu-gu, Incheon, Korea
| | | | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
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Gillinov SM, Varady NH, Abraham PF, Meek WM, Eberlin CT, Small KM, Martin SD. Supraspinatus pathology on MRI is associated with degree of weakness on dynamic clinical strength testing. Skeletal Radiol 2022; 51:1967-1974. [PMID: 35380235 DOI: 10.1007/s00256-022-04049-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 02/02/2023]
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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Affiliation(s)
- Stephen M Gillinov
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Paul F Abraham
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Wendy M Meek
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Christopher T Eberlin
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Kirstin M Small
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott D Martin
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
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Anauate Nicolao F, Yazigi Junior JA, Matsunaga FT, Archetti Netto N, Belloti JC, Tamaoki MJS. Comparing shoulder maneuvers to magnetic resonance imaging and arthroscopic findings in patients with supraspinatus tears. World J Orthop 2022; 13:102-111. [PMID: 35096540 PMCID: PMC8771410 DOI: 10.5312/wjo.v13.i1.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/09/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Shoulder maneuvers and magnetic resonance imaging (MRI) are performed to diagnose supraspinatus tendon tears regardless of arthroscopy exam. Although there are many studies on this subject, there is a lack of studies comparing the sensitivity (Se) and specificity (Sp) of shoulder maneuvers and MRI to arthroscopic findings (intact, partial, or full thickness supraspinatus tendon tear).
AIM To compare the diagnostic values of shoulder maneuvers with MRI for supraspinatus tendon tears in patients undergoing shoulder arthroscopy.
METHODS A total of 199 consecutive patients from four orthopedic centers met the eligibility criteria of shoulder pain persisting for at least four weeks. They were prospectively enrolled in this study from April 2017 to April 2019. Seven clinical tests (full can, empty can, drop arm, Hawkins’, painful arc, Neer’s sign and resisted external rotation) and MRI were performed, and all were compared with surgical findings. Full can, empty can and resisted external rotation tests were interpreted as positive in the case of pain and/or weakness. We assessed the Se, Sp, accuracy, positive predictive value (PPV) and negative predictive value (NPV), positive and negative likelihood ratio and diagnostic odds ratio for overall, partial and full-thickness supraspinatus tears.
RESULTS MRI had the highest Se for overall (0.97), partial (0.91) and full-thickness (0.99) tears; moreover, MRI had the highest NPV: 0.90, 0.88 and 0.98 for overall, partial and full-thickness tears, respectively. For overall supraspinatus tears, the Se and PPV were: Painful arc (Se = 0.85/PPV = 0.91), empty can (pain) (Se = 0.80/PPV = 0.89), full can (pain) (Se = 0.78/PPV = 0.90), resisted external rotation (pain) (Se = 0.48/PPV = 0.87), drop arm (Se = 0.19/PPV = 0.97), Neer’s sign (Se = 0.78/PPV = 0.93) and Hawkins’ (Se = 0.80/PPV = 0.88). MRI had the highest PPV (0.99). The Hawkin’s test had the highest false positive rate in patients with intact tendons (0.36). The Sp of the empty can and full can (both tests positive for pain and weakness), drop arm and MRI were: 0.93, 0.91, 0.98 and 0.96, respectively. For partial and full-thickness tears, the empty can test (positive for pain and weakness) had a Sp of 0.93, and the drop arm and MRI had the same Sp (0.98).
CONCLUSION Physical examination demonstrated good diagnostic value, the drop arm test had a Sp as good as MRI for supraspinatus tears; however, MRI was more accurate in ruling out tears. The Hawkins’ test had high false-positive findings in patients with intact tendons.
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Affiliation(s)
- Fabio Anauate Nicolao
- Orthopedics and Traumatology Department, Escola Paulista de Medicina – Universidade Federal de São Paulo – UNIFESP, Sao Paulo 04038-001, Brazil
- Orthopedics and Traumatology Discipline, Universidade de Santo Amaro – UNISA, Sao Paulo 04829-300, Brazil
| | - Joao Alberto Yazigi Junior
- Orthopedics and Traumatology Department, Escola Paulista de Medicina – Universidade Federal de São Paulo – UNIFESP, Sao Paulo 04038-001, Brazil
- Orthopedics and Traumatology Discipline, Universidade de Santo Amaro – UNISA, Sao Paulo 04829-300, Brazil
| | - Fabio Teruo Matsunaga
- Orthopedics and Traumatology Department, Escola Paulista de Medicina – Universidade Federal de São Paulo – UNIFESP, Sao Paulo 04038-001, Brazil
| | - Nicola Archetti Netto
- Orthopedics and Traumatology Department, Escola Paulista de Medicina – Universidade Federal de São Paulo – UNIFESP, Sao Paulo 04038-001, Brazil
| | - Joao Carlos Belloti
- Orthopedics and Traumatology Department, Escola Paulista de Medicina – Universidade Federal de São Paulo – UNIFESP, Sao Paulo 04038-001, Brazil
| | - Marcel Jun Sugawara Tamaoki
- Orthopedics and Traumatology Department, Escola Paulista de Medicina – Universidade Federal de São Paulo – UNIFESP, Sao Paulo 04038-001, Brazil
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Lazik-Palm A, Kraff O, Rietsch SHG, Ladd ME, Kamminga M, Beck S, Quick HH, Theysohn JM. 7-T clinical MRI of the shoulder in patients with suspected lesions of the rotator cuff. Eur Radiol Exp 2020; 4:10. [PMID: 32030499 PMCID: PMC7005228 DOI: 10.1186/s41747-019-0142-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/06/2019] [Indexed: 01/30/2023] Open
Abstract
Background To evaluate feasibility and diagnostic performance of clinical 7-T magnetic resonance imaging (MRI) of the shoulder. Methods Eight patients with suspected lesions of the rotator cuff underwent 7-T MRI before arthroscopy. Image quality was scored for artifacts, B1+ inhomogeneities, and assessability of anatomical structures. A structured radiological report was compared to arthroscopy. In four patients, a visual comparison with pre-existing 1.5-T examinations was performed. Results Regarding image quality, the majority of the sequences reached values above the middle of each scoring scale. Fat-saturated proton density sequences showed least artifacts and best structure assessability. The most homogenous B1+ field was reached with gradient-echo sequences. Arthroscopy did not confirm tendinopathy/partial tear of supraspinatus in 5/8 patients, of subscapularis in 5/6, and of infraspinatus in one patient; only a partial lesion of the subscapularis tendon was missed. Pathologic findings of long bicipital tendon, acromioclavicular joint, glenohumeral cartilage, labrum, and subacromial subdeltoideal bursa were mainly confirmed; exceptions were one lesion of the long bicipital tendon, one subacromial bursitis, and one superior glenoid labrum anterior-to-posterior lesion, missed on 7-T MRI. Evaluating all structures together, sensitivity was 86%, and specificity 74%. A better contrast and higher image resolution was noted in comparison to previous 1.5-T examinations. Conclusions 7-T MRI of the shoulder with diagnostic image quality is feasible. Overrating of tendon signal alterations was the main limitation. Although the diagnostic performance did not reach the current results of 3-T MRI, our study marks the way to implement clinical 7-T MRI of the shoulder.
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Affiliation(s)
- Andrea Lazik-Palm
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany. .,Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Oliver Kraff
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Stefan H G Rietsch
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany.,High Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Mark E Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany.,Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Physics and Astronomy and Faculty of Physics, University of Heidelberg, Heidelberg, Germany
| | | | - Sascha Beck
- Department of Trauma and Orthopedic Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department of Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Harald H Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany.,High Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Jens M Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
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You T, Frostick S, Zhang WT, Yin Q. Os Acromiale: Reviews and Current Perspectives. Orthop Surg 2019; 11:738-744. [PMID: 31486589 PMCID: PMC6819188 DOI: 10.1111/os.12518] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/28/2019] [Accepted: 07/21/2019] [Indexed: 12/14/2022] Open
Abstract
Os acromiale is a developmental defect which results from the lack of an osseous union between the ossification centers of the acromion, leading to the fibrocartilaginous tissue connection. The prevalence of os acromiale is 1% to 15%, and is quite common in the African American population. Os acromiale in adults is easily diagnosed by symptoms and X-ray, particularly on the axillary view; however, the differential diagnosis of adolescents may require MRI or SPECT-CT. Generally, nonoperative therapy for symptomatic os acromiale should be started, including physiotherapy, nonsteroidal anti-inflammatory drugs, and injections. Surgical treatment is indicated after failed conservative treatment. In symptomatic patients with fixable acromiale, the tension band technique should be used to make the anterior aspect of the acromion elevated from the humerus head. In patients with small fragments which are unsuitable for reattachment, excision might be the best therapeutic option and lead to good outcomes. Whether using internal fixation or resection, the arthroscopic technique results in a better outcome and fewer complications, especially in older patients or athletes with overhead movement, because of the high incidence of shoulder impingement or rotator cuff tears which can be treated concurrently.
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Affiliation(s)
- Tian You
- Sports Medicine Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Simon Frostick
- Department of Orthopaedic Surgery, Royal Liverpool University Hospital, Liverpool, UK
| | - Wen-Tao Zhang
- Sports Medicine Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Qi Yin
- Department of Orthopaedic Surgery, Royal Liverpool University Hospital, Liverpool, UK
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Yazigi Junior JA, Anauate Nicolao F, Archetti Netto N, Matsunaga FT, Lim Lee JH, Torres Ogata SY, Sugawara LM, Aihara AY, Sugawara Tamaoki MJ. Magnetic resonance imaging reproducibility for rotator cuff partial tears in patients up to 60 years. BMC Musculoskelet Disord 2019; 20:383. [PMID: 31431192 PMCID: PMC6702712 DOI: 10.1186/s12891-019-2760-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/09/2019] [Indexed: 01/30/2023] Open
Abstract
Background Magnetic resonance imaging (MRI) is the gold standard in diagnosing rotator cuff pathology; however, there is a lack of studies investigating the reliability agreement for supraspinatus partial-thickness tears among orthopaedic surgeons and musculoskeletal (MSK) radiologists. Methods Sixty digital MRI scans (1.5 Tesla) were reviewed by two orthopaedic shoulder surgeons, two MSK radiologists, two fellowship-trained shoulder surgeons, and two fellowship-trained orthopaedic surgeons at two distinct times. Thirty-two scans of partial-thickness tears and twenty-eight scans of the supraspinatus tendon with no tears were included. Supraspinatus tendonosis and tears, long head of the biceps pathology, acromial morphology, acromioclavicular joint pathology and muscle fatty infiltration were assessed and interpreted according to the Goutallier system. After a four-week interval, the evaluators were asked to review the same scans in a different random order. The statistical analyses for the intra- and interobserver agreement results were calculated using the kappa value and 95% confidence intervals. Results The intraobserver agreement for supraspinatus tears was moderate among the MSK radiologists (k = 0.589; 95% CI, 0.446–0.732) and the orthopaedic shoulder surgeons (k = 0.509; 95% CI, 0.324–0.694) and was fair among the fellowship-trained shoulder surgeons (k = 0.27; 95% CI, 0.048–0.492) and the fellowship-trained orthopaedic surgeons (k = 0.372; 95% CI, 0.152–0.592). The overall intraobserver agreement was good (k = 0.627; 95% CI, 0.576–0.678). The intraobserver agreement was moderate for biceps tendonosis (k = 0.491), acromial morphology (k = 0.526), acromioclavicular joint arthrosis (k = 0.491) and muscle fatty infiltration (k = 0.505). The interobserver agreement results for supraspinatus tears were fair and poor among the evaluators: the MSK radiologists and the orthopaedic shoulder surgeons had the highest agreement (k = 0.245; 95% CI, 0.055–0.435). Conclusions In this sample of digital MRI scans, there was an overall good intraobserver agreement for supraspinatus partial tears; however, there were also poor and fair interobserver agreement results. The evaluators with higher levels of experience (the orthopaedic shoulder surgeons and the MSK radiologists) demonstrated better results than evaluators with lower levels of experience. Electronic supplementary material The online version of this article (10.1186/s12891-019-2760-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- João Alberto Yazigi Junior
- Orthopedics and Traumatology - Division of Hand Surgery and Upper Limb, Federal University of São Paulo (UNIFESP/EPM), Borges Lagoa Road, 776, São Paulo, 04038-030, Brazil.
| | - Fábio Anauate Nicolao
- Orthopedics and Traumatology - Division of Hand Surgery and Upper Limb, Federal University of São Paulo (UNIFESP/EPM), Borges Lagoa Road, 776, São Paulo, 04038-030, Brazil
| | - Nicola Archetti Netto
- Orthopedics and Traumatology - Division of Hand Surgery and Upper Limb, Federal University of São Paulo (UNIFESP/EPM), Borges Lagoa Road, 776, São Paulo, 04038-030, Brazil
| | - Fabio Teruo Matsunaga
- Orthopedics and Traumatology - Division of Hand Surgery and Upper Limb, Federal University of São Paulo (UNIFESP/EPM), Borges Lagoa Road, 776, São Paulo, 04038-030, Brazil
| | - Jéssica Hae Lim Lee
- Orthopedics and Traumatology - Division of Hand Surgery and Upper Limb, Federal University of São Paulo (UNIFESP/EPM), Borges Lagoa Road, 776, São Paulo, 04038-030, Brazil
| | - Stéphanie Yuri Torres Ogata
- Department of Radiology, Federal University of São Paulo (UNIFESP/EPM), Borges Lagoa Road, 776, São Paulo, 04038-030, Brazil
| | - Leonardo Massamaro Sugawara
- Department of Radiology, Federal University of São Paulo (UNIFESP/EPM), Borges Lagoa Road, 776, São Paulo, 04038-030, Brazil
| | - André Yui Aihara
- Department of Radiology, Federal University of São Paulo (UNIFESP/EPM), Borges Lagoa Road, 776, São Paulo, 04038-030, Brazil
| | - Marcel Jun Sugawara Tamaoki
- Orthopedics and Traumatology - Division of Hand Surgery and Upper Limb, Federal University of São Paulo (UNIFESP/EPM), Borges Lagoa Road, 776, São Paulo, 04038-030, Brazil
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Sambandam SN, Khanna V, Gul A, Mounasamy V. Rotator cuff tears: An evidence based approach. World J Orthop 2015; 6:902-918. [PMID: 26716086 PMCID: PMC4686437 DOI: 10.5312/wjo.v6.i11.902] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/04/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, cost-effective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.
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