The coracoacromial arch: MR evaluation and correlation with rotator cuff pathology (original) (raw)
Related papers
Correlation of acromial morphology in association with rotator cuff tear: a retrospective study
Polish Journal of Radiology, 2019
Purpose: There have been many studies that have attempted to correlate radiographic acromial characteristics with rotator cuff tears, but the results have not been conclusive. Rotator cuff tears (RCT) are the common aetiology of shoulder pain. We assessed the association of rotator cuff tears with commonly used radiographic parameters of acromial morphology and their different radiographic characteristics. Material and methods: From a retrospective study of 98 patients, we characterised acromial type and measured acromial thickness (AT), critical shoulder angle (CSA), lateral acromial angle (LAA), acromiohumeral distance (AHD), and acromion index (AI) on a 1.5T MRI, from 68 patients with partial or full-thickness supraspinatus tendon tears and 30 controls without tears. Results: Out the 68 patients with rotator cuff tear, supraspinatus was the most commonly affected tendon, with 86% (59) cases showing abnormalities. The average age of the patients was 45.11 ± 21.45 years with male dominance (80%). Partial tears of rotator cuff were more common than complete tears. Forty-eight cases showed partial tears in supraspinatus as compared to 11 cases of complete tears. The acromial type did not show any correlation with any particular cuff lesion. The AT and AI of controls were significantly smaller than cuff-tear patients. The LAA of cuff-tear patients was significantly different from that of control patients. The impingement patients demonstrated a significantly greater acromial thickness, larger CSA, decreased AHD, and decreased LAA than their control counterparts. Conclusions: A higher prevalence of rotator cuff tears and impingement associated with low lateral acromial angle, larger CSA and decreased AHD was observed. AT and AI have a direct correlation with rotator cuff tear.
Journal of Shoulder and Elbow Surgery, 2012
Background: Many studies have attempted to correlate radiographic acromial characteristics with rotator cuff tears, but the results have not been conclusive. Therefore, the purpose of this study was to determine the relationship between rotator cuff disease and the development of symptoms with different radiographic acromial characteristics, including shape, index, and presence of a spur. Materials and methods: The records of 216 patients enrolled in an ongoing prospective, longitudinal study investigating asymptomatic rotator cuff tears were reviewed. All patients underwent standardized radiographic evaluation, clinical evaluation, and shoulder ultrasonography at regularly scheduled surveillance visits. Three blinded observers reviewed all radiographs to determine the acromial morphology, presence, and size of an acromial spur, as well as the acromial index. These findings were analyzed to determine an association with the presence of a full-thickness rotator cuff tear. Results: The 3 observers demonstrated poor agreement for acromial morphology (k ¼ 0.41), substantial agreement for the presence of an acromial spur (k ¼ 0.65), and excellent agreement for the acromial index (k ¼ 0.86). The presence of an acromial spur was highly associated with the presence of a full-thickness rotator cuff tear (P ¼ .003), even after adjusting for age. No association was found between the acromial index and rotator cuff disease (P ¼ .92). Conclusion: The presence of an acromial spur is highly associated with the presence of a full-thickness rotator cuff tear in symptomatic and asymptomatic patients. The acromial morphology classification system is an unreliable method to assess the acromion. The acromial index shows no association with the presence of rotator cuff disease. Level of evidence: Level III, Cross-Sectional Study Design, Epidemiology Study.
Knee Surgery, Sports Traumatology, Arthroscopy, 2020
Purpose To compare the critical shoulder angle (CSA), acromion index (AI), acromion angulation (AA) and glenoid version angle (GVA) between patients with full-thickness rotator cuff tears (RCTs) and patients with intact rotator cuffs. Methods Between 2014 and 2018, the CSA, AI, AA and GVA were measured in consecutively included patients aged > 40 years who underwent shoulder arthroscopy for full-thickness RCTs. A total of 437 patients with RCTs and a mean age of 51.2 years (± 5.8) were included, 35.7% of whom were male. In the control group, there were n = 433 patients (36.3% male) with an intact rotator cuff, and the mean age was 50.7 years (± 5.3). Results The mean AI for the RCT group was 0.7 ± 0.1, which was significantly higher than the mean AI for the control group (0.6 ± 0.1, p < 0.001). The mean CSA for the RCT group was 33.6° ± 3.9°, which was significantly higher than the mean CSA for the control group (31.5° ± 4°, p < 0.001). The mean AA for the RCT group was 13.9° ± 9°, which was significantly higher than the mean AA for the control group (12.4 ± 8.6, p = 0.012). The mean GVA for the RCT group was − 3.5° ± 4.6° and significantly retroverted compared with the mean GVA for the control group (− 2.2° ± 4.6°, p < 0.001). The cutoff values determined by the ROC curve analyses were as follows: 0.6 for AI, 31.4° for CSA, 9.6° for AA and − 2.6° for GVA. Conclusion The CSA, AI, GVA and AA values measured by MRI were determined to be significantly related to full-thickness rotator cuff ruptures. The AI, CSA, AA and GVA may be considered risk factors for degenerative rotator cuff tears. Assessing the CSA, AI, GVA and AA can be helpful for diagnostic evaluation of patients with full-thickness RCTs. Level of evidence III.
MR Evaluation of Factors Predicting the Development of Rotator Cuff Tears
Journal of Computer Assisted Tomography, 2001
The purpose of this work was to assess the incidence of various factors predicting impingement in the shoulder. Method: MR examination was used to assess various anatomic parameters in 46 patients with clinical abnormalities of the shoulder and 40 asymptomatic volunteers. All patients had undergone surgery, showing no rotator cuff tear. Results: A few of the parameters evaluated were significantly different in the two groups: The acromion was more frequently curved or hook-shaped in patients than in volunteers. The acromiohumeral distances differed (4.87 mm in patients and 6.05 mm in volunteers); so did the coracohumeral distances (7.9 mm in patients and 8.9 mm in volunteers). The shape of the acromioclavicular joint and the anterior covering of the humerus, defined on the coronal view, also differed (1.07 mm in patients and 1.49 mm in volunteers). Only the shapes of the acromioclavicular joint and of the acromion were linked with age. Conclusion: All these factors reflected a decrease in the acromiohumeral space, except for the anterior covering of the acromial arch, which could be due to anterior instability.
The coracoacromial ligament: The morphology and relation to rotator cuff pathology
Journal of Shoulder and Elbow Surgery, 2008
We dissected 80 shoulders from 44 fresh cadavers to define variants of the coracoacromial ligament and their relationship to rotator cuff degeneration. The shapes and the geometric data of the ligaments were investigated, and the rotator cuffs of the cadavers were evaluated macroscopically. Five main types of coracoacromial ligaments were found: Y-shaped, broad band, quadrangular, V-shaped, and multiple-banded. The Y-shaped ligament was the most frequent type, with a frequency of 41.3%, and the V-shaped ligament (11.2%) has not been previously reported. Of the cadavers that were dissected bilaterally, 64% showed the same type of ligament. There was no statistical significance between rotator cuff degeneration and the type or geometric measurement of the ligament. However, the coracoacromial ligaments with more than 1 bundle showed significant association with rotator cuff degeneration with a longer lateral border and larger coracoid insertion. (J Shoulder Elbow Surg 2008;17:182-188.)
Background: The purpose of this study was to investigate the role of coracoacromial ligament degener-ation and specific anatomic parameters in the etiology of partial-thickness rotator cuff tears. Materials and Methods: This study retrospectively assessed 96 patients (mean age, 50.1 years [17-76]; 34 men, 62 women) diagnosed with bursal-side and articular-side rotator cuff tears with a history of failed conservative treatment and persistent shoulder pain who underwent arthroscopic surgery. Video records of the surgery were used to evaluate the type of cuff tear, grade of coracoacromial ligament degeneration, and associated pathologic changes; preoperative magnetic resonance images were used to measure acromioglenoid angle, supraspinatus glenoid angle, and subacromial distance. Results: Most of the patients with articular-side tears demonstrated grade 0 and grade 1 coracoacromial ligament degeneration, whereas patients with bursal-side tears had grade 1 and grade 2. There was a significant positive correlation between the grade of coracoacromial ligament degeneration and bursal-side partial rotator cuff tears, whereas no correlation was observed with articular-side tears. There was no significant difference between bursal-side and articular-side partial cuff tears regarding acromioglenoid angle, supraspinatus glenoid angle, and subacromial distance. Conclusions: Grade 1 and grade 2 coracoacromial ligament degeneration is a strong predictive factor for impingement syndrome in the etiology of bursal-side partial cuff tears and can guide the surgeon to consider ligament release and débridement or acromioplasty in these patients. Level of evidence: Level IV; Case Series; Prognosis Study
Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, 2020
The aim of this study is to evaluate the presence of significant differences regarding the lateral acromial angle, critical shoulder angle, and the acromial index between patients with and without rotator cuff tears. Method: The MRIs (Magnetic Resonnance Imaging) of 82 patients were studied. The rotator cuff tear group (RCT group) included 41 patients while the control group also included 41 patients without rotator cuff tears. Acromial parameters and demographical data were extracted for statistical analysis. Results: No statistical significant difference was found in terms of the studied acromial parameters between patients with and without rotator cuff tears. No correlation was found between age and any of the studied parameters. LAA (Lateral Acromial Angle) was found to be significantly different between males and females of the studied sample. However, no difference was found between patients with and without rotator cuff tears when both genders were studied separately. Moreover, no statistical significant difference was found in terms of the studied acromial parameters between males and females when the RCT group and the control group were studied separately. When gender was the covariate in the one-way MANCOVA test, gender was not significantly dependent on the type of groups (RCT group vs control group). Conclusion: The results obtained from this study suggested that the studied acromial parameters in patients with rotator cuff tears were not different from the parameters found in patients without rotator cuff tears. Moreover, gender was not found to influence the acromial parameters, with no subsequent effect on the development of rotator cuff tears. Further studies may be required for better understanding on the biomechanics, taking into consideration age, gender, and the given population.
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.
2014
The coracoacromial ligament represents a strong triangular band, which extends between the coracoid process and the acromion. Its function is related to the formatio n of vault for the protection of the humeral head together with the acromion and the coracoid process. During routine dissection in the section hall of the Department of Anatomy and Histology in Medical University - Sofia we came across a very interesting variation of the coracoacromial ligament. It consists of two parts joining together to the acromion. These bands attached respectively to the apex and the base of the coracoid process. There is a fibrous connective tissue and a gap between two bands of the coracoacromial ligament. Two bands combined in a common portion joining together to the acromion. We observed the presence of a deformation of the humeral head and the osteoarthritis in the shoulder joint. The severe osteoarthritis changes were accompanied with the absence of cartilage on the humeral head in the inve...
2014
The coracoacromial ligament represents a strong triangular band, which extends between the coracoid process and the acromion. Its function is related to the formation of vault for the protection of the humeral head together with the acromion and the coracoid process. During routine dissection in the section hall of the Department of Anatomy and Histology in Medical University-Sofia we came across a very interesting variation of the coracoacromial ligament. It consists of two parts joining together to the acromion. These bands attached respectively to the apex and the base of the coracoid process. There is a fibrous connective tissue and a gap between two bands of the coracoacromial ligament. Two bands combined in a common portion joining together to the acromion. We observed the presence of a deformation of the humeral head and the osteoarthritis in the shoulder joint. The severe osteoarthritis changes were accompanied with the absence of cartilage on the humeral head in the investigated shoulder joint. In our case the question arises whether the ligament is adherent intimately to the undersurface of the overlying anterior deltoid muscle especially the deltoid fascia. It may be the main reason for the impingement syndrome during lifetime. The impingement syndrome very often is a cause for the pain in shoulder and may lead to operative treatment, which in turn leads to a period of temporary disability. It is clear that the variations of the acromion and the coracoacromial ligament are important since, in turn, they can lead to the impingement syndrome. .