Magnetic Resonance Imaging of Pectoralis Major Injuries in an Active Duty Military Cohort: Mechanism Affects Tear Location (original) (raw)
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Abstract Introduction: Rotator cuff tear (RCT) is one of the most common causes of shoulder pain and limitation of shoulder movements for which a patient presents to the clinic. MRI is the first choice of investigation for RCT but the accuracy of MRI in detection of Partial tendon tear(PTT) is still a topic of debate among researchers. Objective: The objective of this study is to re-evaluate the diagnostic efficacy of MRI for the detection of PTT and FTT using surgical finding as the ‘gold standard ‘ by improving the limitations of previous studies. Methods: All patients between January 2012 to January 2017 were preoperatively evaluated by means of complete orthopedic history, physical examination and MRI of the affected shoulder.The initial inspection of all the data only included 110 patients who had both MRI of the affected shoulder joints and subsequent surgery. Among them 13 patients were excluded as they did not undergo either arthroscopic or open surgery. In addition to that 4 more patients were excluded because of a time interval between MRI and surgery exceeded 2 months. The final study group consisted of 93 shoulders from 93 cases (63 female and 30 male) with the mean age of 56.85 years and range of 19 to 83 years. Kappa coefficient test was used to calculated the agreement between the MRI and surgical findings. A P-value less than 0.05 was considered statistically significant. Sensitivity, specificity, accuracy, the positive predictive value and the negative predictive value were calculated based on the cross tables. Results: MRI was able to correctly identify full thickness tear in 9 out of 10 patients with sensitivity, specificity, positive predictive value and negative predictive value of 90.0%, 100%, 100%, 98.9% and partial thickness tear in 70 out of 78 cases with sensitivity, specificity, positive predictive value and negative predictive value of 89.7%, 60%, 92.1%, 52.9% respectively. The accuracy for detection of FTT was 98.9% and PTT was 84.9% and the p value for both tears (FTT and PTT) was less than 0.05. There was a moderate agreement between MRI and surgery for PTT with k value of 0.472 and excellent agreement for FTT with k value of 0.94 . Conclusion: MRI has high accuracy, sensitivity and positive predictive value in diagnosis of both PTT and FTT and also provides an additional information about tendon, muscle and labrum, all of which are pivotal in better management of tear and improving the prognosis.
International Orthopaedics, 2018
Purpose Magnetic resonance (MRI) is a valuable imaging method which can detect pre-operative rotator cuff tear characteristics accurately. However, tendon degeneration almost always necessitates a certain amount of debridement during arthroscopic repair, which alters tear size and shape. The aim of this study is to question the accuracy of the pre-operative tear size and classification in MRI and its relation to the tear size and type of the debrided tendon during arthroscopic repair. Methods A retrospective survey was performed to identify shoulders that underwent arthroscopic rotator cuff repair. Rotator cuff tears with an adequate history, a standard pre-operative MRI, and available surgical video records with appropriate measurements were included. Traumatic tears, calcifying tendonitis, isolated subscapularis tears, and revisions were excluded. In total, 60 shoulders' (30 males, 27 females; age 55.2 [35-73]) preoperative MRIs and intra-operative measurements were analyzed by orthopaedic surgeons and radiologists. Tear width and type were recorded. Interdisciplinary and intradisciplinary consistency of measurements and classifications were analyzed. Tear width measured on pre-operative MRI and after debridement were compared. Results Average measured tear width was 9 ± 5.3 mm on MRI. Surgeons (9.98 ± 4.6 mm) measured tears significantly wider than radiologists (7.71 ± 6.6 mm). Radiologists (ICC, 0.930; CI, 0.883-0.959) showed superior consistency on MRI than surgeons (CI, 0.502; CI, 0.105-0.726). Average tear width measured after debridement (29.3 ± 9.6 mm) was significantly higher than tear width measured on pre-operative MRI (p < 0.0001). None of the researchers assessing tear type on pre-operative MRI showed agreement with surgeons assessing intra-operative data. Conclusions There were significant differences between the pre-operative tear characteristics on MRI and the debrided tendon characteristics during surgery, which were extensive enough to classify the tear in a different category.
Interobserver Agreement in the Classification of Rotator Cuff Tears Using Magnetic Resonance Imaging
The American Journal of Sports Medicine, 2007
Background Although magnetic resonance imaging (MRI) is a standard method of assessing the extent and features of rotator cuff disease, the authors are not aware of any studies that have assessed the interobserver agreement among orthopaedic surgeons reviewing MRI scans for rotator cuff disease. Hypothesis Fellowship-trained orthopaedic shoulder surgeons will have good interobserver agreement in predicting the more salient features of rotator cuff disease such as tear type (full thickness versus partial thickness), tear size, and number of tendons involved but only fair agreement with more complex features such as muscle volume, fat content, and the grade of partial-thickness cuff tears. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods Ten fellowship-trained orthopaedic surgery shoulder specialists reviewed 27 MRI scans of 27 shoulders from patients with surgically confirmed rotator cuff disease. The ability to interpret full-thickness versus partial-thickness te...
Role of Magnetic Resonance Imaging in the Evaluation of Rotator Cuff Tears
Cureus, 2022
Background Magnetic resonance imaging (MRI), with the advent of surface coils, is becoming the modality of choice for imaging soft tissues around the shoulder joint. Good knowledge regarding the MR characteristics of rotator cuff tendons, acromion, and the abnormalities in these tendons is necessary for appropriate diagnosis. Methods This was a hospital-based descriptive, analytical and prospective study conducted at our tertiary care hospital. The study was performed on 50 patients with rotator cuff lesions detected on MRI of the shoulder joint. Results The age distribution found in the study is between 19 and 66 years with mean being 43 ± 14.8 years. The peak incidence was found in the fifth and sixth decades of life. Gender-wise distribution of rotator cuff pathologies has shown no significant gender variation. The pain was the most common presenting complaint. An abnormal supraspinatus tendon was seen in 82% of the 50 study patients, making it the most commonly affected tendons, followed by subscapularis and infraspinatus tendons. No apparent teres minor pathology was identified in the study patients. The most common pathology affecting the supraspinatus tendon was tendinosis (38%) closely followed by a partial tear (36%). Among the partial tears, the articular surface type of tear was the most common. About 52% patients had type II (curved) acromion; making it the most common type of acromion followed by type III (hook), supraspinatus tendinopathy was more common in type II acromion. A reduction in the acromiohumeral distance can cause supraspinatus tendinosis and also makes it more susceptible to tear. About 45.5% showed supraspinatus tendon tears when the acromiohumeral distance was less than 8mm as compared to 13.6% when more than 10mm. Only 4.2% had normal supraspinatus tendon in patients with this distance less than 7mm. Conclusion MRI provides valuable information to the orthopaedic surgeon regarding the status of tendons, bones, and joints. In order to choose the appropriate course of action, it is crucial first to identify the issue and report relevant data from rotator cuff imaging. A full grasp of the rotator cuff's architecture and function, as well as the repercussions of rotator cuff diseases, is required.
US and MR Imaging of Pectoralis Major Injuries
Radiographics : a review publication of the Radiological Society of North America, Inc
During the past 2 decades, the frequency of pectoralis major muscle injuries has increased in association with the increased popularity of bench press exercises. Injury of the pectoralis major can occur at the muscle origin, muscle belly, musculotendinous junction, intratendinous region, and/or humeral insertion-with or without bone avulsion. The extent of the tendon injury ranges from partial to complete tears. Treatment may be surgical or conservative, depending on the clinical scenario and anatomic characteristics of the injury. The radiologist has a critical role in the patient's treatment-first in detecting and then in characterizing the injury. In this article, the authors review the normal anatomy and anatomic variations of the pectoralis major muscle, classifications and typical patterns of pectoralis major injuries, and associated treatment considerations. The authors further provide an instructive guide for ultrasonographic (US) and magnetic resonance (MR) imaging eval...
Magnetic resonance imaging reproducibility for rotator cuff partial tears in patients up to 60 years
BMC Musculoskeletal Disorders
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.
Magnetic Resonance Imaging, 2012
This review concluded that magnetic resonance imaging (MRI) had excellent accuracy for the detection of fullthickness rotator cuff tears, but was less accurate for partial-thickness tears. The authors also concluded that higher field strength (3.0T) MRI systems were more accurate. These conclusions appear to be an over interpretation of the data presented. Authors' objectives To assess the diagnostic test accuracy of magnetic resonance imaging (MRI) in the detection of partial-and fullthickness rotator cuff tears in adults. Searching Several sources were searched from inception to May 2011 including Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and Zetoc. Grey literature was searched using the following databases: OpenSIGLE, International Clinical Trials Registry Platform, Current Controlled Trials, UKCRN Portfolio Database, National Technical Information Service and the UK National Research Register Archive. An example search strategy was reported. Experts in the field were contacted and the bibliographies of retrieved articles were screened for additional studies. Study selection Studies of any design that assessed the accuracy of MRI for diagnosing rotator cuff (supraspinatus, infraspinatus, teres minor, subscapularis) tear pathology in adults were eligible for inclusion. Studies were required to use to either arthroscopic or open surgical findings as the reference standard to confirm diagnosis. Studies that solely assessed the diagnostic test accuracy of magnetic resonance arthrography were excluded. The mean age of study participants was 47.8 years. Approximately half of the included studies used MRI field strength of 1.5T; field strengths ranged from 0.5 to 3.0T. Approximately half of the included studies reported that MRI examinations were reviewed by one or more specialist musculoskeletal radiologists. The time elapsing between MRI examination and reference standard confirmation ranged from less than two weeks to 3.8 months. One reviewer screened retrieved titles and abstracts for relevance. The full texts of potentially eligible studies were assessed for inclusion by one reviewer and independently checked by two other reviewers. Assessment of study quality The methodological quality of included studies was assessed using the 14-item QUADAS tool. Two reviewers independently assessed study quality and assessments were checked by a third reviewer. Disagreements were resolved by discussion. Data extraction Numbers of true positive, false negative, false positive and true negative MRI results were extracted. These data were used to calculate separate sensitivity and specificity values, with 95% confidence intervals (CIs) for the detection of partial-and full-thickness rotator cuff tears. Data were extracted by one reviewer and checked by a second reviewer. Study authors were contacted for additional information where necessary.
Isolated traumatic pectoralis minor tendon tear in a young adult diagnosed with MRI
Radiology Case Reports
This is a rare case of an isolated pectoralis minor partial-thickness tendon tear in a 24-yearold man who was involved in a major trauma. The purpose of this paper is to report the clinical signs, symptoms, cross-sectional imaging findings, and management of an isolated pectoralis minor tendon tear. Furthermore, this case represents a novel traumatic mechanism of injury, as opposed to the classic sports-related pectoralis minor tendon tear injury. The current limited body of literature on isolated pectoralis minor tendon tears is reviewed.
Acta Radiologica, 2014
Background: Magnetic resonance imaging (MRI) is considered to be the best non-invasive procedure for the evaluation of rotator cuff (RC) tendon tears. Burkhart's classification is a geometric classification of full-thickness RC tears on MRI. Purpose: To correlate MRI and arthroscopic geometric full-thickness RC tears according to the Burkhart's classification with pre-and postoperative clinical findings. Material and Methods: Patients who underwent arthroscopic RC repair between 2006 and 2010 were retrospectively evaluated. Preoperative MRI and arthroscopic surgical reports were reviewed for tear geometry (Burkhart's) by three (1 radiologist, 2 surgeons) and two (surgeons) readers. MRIs were also evaluated for tear size and change of tear size in successive sagittal sections and for muscle mass and fatty infiltration. Clinical examinations were performed preoperatively and at least 12 months afterwards. Postoperative function questionnaires were filled in by the patients. Results: Forty-six patients (35 men, 11 women; mean age, 57 years; range, 41-72 years) were evaluated. Tears depicted on MRIs were classified as crescent in 11 patients (24%), longitudinal in three (6.5%), massive contracted in 29 (63%), and cuff arthropathy in three (6.5%). Muscle changes were noted almost exclusively in patients with massive tears and cuff arthropathy (16/32 patients, P ¼ 0.013). MRIs and arthroscopic geometric classifications were in close agreement. Tear type did not correlate with pre-and postoperative physical examination or with postoperative clinical questionnaires scores. Conclusion: Geometric RC tear characterizations on preoperative MRIs were closely associated with arthroscopic findings. Postoperative results were not affected by the geometric pattern of the tears.