Effectiveness Of Plain Shoulder Radiograph In Detecting Degenerate Rotator Cuff Tears (original) (raw)
Related papers
Journal of orthopaedic surgery and research, 2014
It is unknown which combination of patient information and clinical tests might be optimal for the diagnosis of rotator cuff tears. This study aimed to determine the diagnostic value of nine individual clinical tests for evaluating rotator cuff tear and to develop a prediction model for diagnosing rotator cuff tear. This prospective cohort study included 169 patients with shoulder complaints. Patients who reported a previous shoulder dislocation were excluded from the analysis (N = 69). One experienced clinician conducted 25 clinical tests of which 9 are specifically designed to diagnose rotator cuff pathology (empty can, Neer, Hawkins-Kenney, drop arm, lift-off test, painful arc, external rotation lag sign, drop sign, infraspinatus muscle strength test). The final diagnosis, based on magnetic resonance arthrography (MRA), was determined by consensus between the clinician and a radiologist, who were blinded to patient information. A prediction model was developed by logistic regress...
International Journal of Orthopaedics, 2020
INTRODUCTION: We propose a new radiographic classification of greater tuberosity changes seen in patients with atraumatic rotator cuff dysfunction. The aim of this study is to determine the predictive values and accuracy of this classification for the detection of rotator cuff tears using arthroscopic findings as the gold standard. STUDY DESIGN & METHODS: This was a retrospective study of 91 consecutive patients (47 male, 44 female; mean age 57 year old) who underwent shoulder arthroscopy for a clinical diagnosis of rotator cuff dysfunction. The presence and size of a rotator cuff tear for each patient had been documented at the time of surgery. The radiographs were anonymised and randomised for interpretation by 2 experienced shoulder surgeons and of 2 orthopaedic residents newly-educated on the use of the classification. The predicative values of the new classification for the diagnosis of rotator cuff tear were calculated. Inter-rater agreement values were obtained using the Fliess’ kappa method. Statistical significance was set at p < 0.05. RESULTS: Comparative statistics showed that Stage 0 or 1 were associated with the absence of a cuff tear. Stage 2 and 3 were strongly predictive of a rotator cuff tear. The mean predicative values of the new classification stage 2 and 3 for the detection of a rotator cuff tear were: sensitivity 93%, specificity 83%, positive predictive value 87%, and negative predictive value 92%. The accuracy of the experienced observer group was significantly higher than the inexperienced group (97% v 83%, p-value <0.01) and therefore the overall group accuracy was 89%. Inter-rater agreement for stages 1, 2 and 3 changes was substantial overall (Kappa value of 0.63) and almost perfect between the experienced assessors (Kappa=0.95) CONCLUSIONS: The new classification is a useful adjunct for the diagnosis of rotator cuff tears where adequate radiographs are available. It may be used as a screening test in a large number of patients with shoulder pain and select stage 2 and 3 patients for further rotator cuff imaging to assist preoperative planning.
Detection of Rotator Cuff Tears by Surgeon-Performed Ultrasound Scan
International Journal of Orthopaedics, 2020
INTRODUCTION: The aim of this study was to determine whether the greatest diagnostic accuracy for the detection of a surgically relevant rotator cuff tear is provided by a scan in the radiology department, either ultrasound or Magnetic resonance, or by an ultrasound scan performed in the clinic by a shoulder surgeon. MATERIALS AND METHODS: Consecutive patients due to undergo an arthroscopy for rotator cuff disease were scanned by the operating surgeon. The presence or absence of a surgically relevant cuff tear on scan was compared with arthroscopic findings as gold standard. The surgeon’s log was then compared with the radiologist results of both ultrasound and MRI performed for the same patients in our institution. Subgroup analysis was performed to compare the results of scans reported by specialist and non-specialist radiologists. RESULTS: Surgeon-performed Ultrasound scan on 88 shoulders was compared to 57 departmental Magnetic resonance scans and 41 departmental Ultrasound scans. Compared to the predictive values obtained for all radiology reported scans combined, Surgeon-US had significantly greater specificity (98.2 vs 81.8, p = 0.008), Positive predictive value (97.6 vs 79.6, p = 0.010), and overall accuracy (95.0 vs 84.0, p = 0.019). No significant difference was found on comparing sensitivity (91.1 vs 86.7) or Negative predictive value (93.2 vs 88.2). CONCLUSION: A surgeon performed Ultrasound scan for the detection of surgically relevant rotator cuff tears can provide equal accuracy to departmental Magnetic resonance or specialist radiologist-performed US and better accuracy than US performed by a non-specialist radiologist. These findings support the development of ‘one stop’ shoulder clinics. To our knowledge, this is the first study to directly compare both radiology-reported US and MRI with surgeon-performed US in the same group of patients.
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.
Annals of The Royal College of Surgeons of England, 2006
INTRODUCTION Rotator cuff tears are a common pathology, with a varied prevalence reported. PATIENTS AND METHODS A literature review was undertaken to determine the cadaveric and radiological (ultrasonography and magnetic resonance imaging [MRI]) prevalence of rotator cuff tear. The radiological studies were subdivided into symptomatic and asymptomatic subjects. RESULTS Cadaveric rotator cuff tears were found in 4629 shoulders of which only 2553 met the inclusion criteria. The prevalence of full-thickness tears was 11.75% and partial thickness 18.49% (total tears 30.24%). The total tear rate in ultrasound asymptomatic was 38.9% and ultrasound symptomatic 41.4%. The total rate in MRI asymptomatic was 26.2% whilst MRI symptomatic was 49.4%. DISCUSSION The unselected cadaveric population should contain both symptomatic and asymptomatic subjects. A prevalence of tears between the symptomatic and asymptomatic radiological groups would be expected. However, apart from the MRI asymptomatic ...
Rotator cuff tears in asymptomatic individuals: a clinical and ultrasonographic screening study
European journal of …, 2004
Objective: To determine the prevalence and clinical impact of rotator cuff tears in asymptomatic volunteers. Materials and Methods: Sonographic examinations of the shoulder of 212 asymptomatic individuals between 18 and 85 years old were performed by a single experienced operator. The prevalence and location of complete rotator cuff tears were evaluated. The clinical assessment was based on the Constant Score. Magnetic resonance imaging (MRI) of the shoulder was obtained in those patients where US showed rotator cuff pathology. Results: Ultrasound showed a complete rupture of the supraspinatus tendon in 6% of 212 patients from 56 to 83 years of age (mean: 67 years). MRI confirmed a complete rupture of the supraspinatus tendon in 90%. All patients reported no functional deficits, although strength was significantly lower in the patient group with complete supraspinatus tendon tear (P<0.01). Conclusion: There is a higher prevalence in older individuals of rotator cuff tendon tears that cause no pain or decrease in activities of daily living.
Journal of orthopaedic surgery and research, 2017
Rotator cuff tears are very common and their incidence increases with age. Shoulder ultrasonography has recently gained popularity in detecting rotator cuff tears because of its efficiency, cost-effectiveness, time-saving, and real-time nature of the procedure. Well-trained orthopedic surgeons may utilize shoulder ultrasonography to diagnose rotator cuff tears. The wait time of patients planned to have shoulder MRI (magnetic resonance imaging) to rule in rotator cuff tears may decrease after orthopedic surgeon start doing shoulder ultrasonography as a screening tool for that. Patients with rotator cuff tears may be detected earlier by ultrasonography and have expedited surgical repair. The efficacy in determination of rotator cuff tears will also increase. Patients were retrospectively reviewed from January 2007 to December 2012. They were divided into 2 groups: Ultrasound (-) group and the Ultrasound (+) group. Age, gender, wait time from outpatient department (OPD) visit to MRI ex...
Journal of Orthopaedic Surgery and Research, 2011
Background: This study evaluates the preoperative conventional anteroposterior radiography and clinical testing in non-operated patients with cuff tear arthropathy. It analyses the radiological findings in relation to the status of the rotator cuff and clinical status as also the clinical testing in relation to the rotator cuff quality. The aim of the study is to define the usefulness of radiography and clinical examination in cuff tear arthropathy. Methods: This study analyses the preoperative radiological (AP-view, (Artro-)CT-scan or MRI-scan) and clinical characteristics (Constant-Murley-score plus active and passive mobility testing) and the peroperative findings in a cohort of 307 patients. These patients were part of a multicenter, retrospective, consecutive study of the French Orthopaedic Society (SOFCOT-2006). All patients had no surgical antecedents and were all treated with prosthetic shoulder surgery for a painful irreparable cuff tear arthropathy (reverse-(84%) or hemi-(8%) or double cup-bipolar prosthesis (8%)). Results: A positive significancy could be found for the relationship between clinical testing and the rotator cuff quality; between acromiohumeral distance and posterior rotator cuff quality; between femoralization and posterior rotator cuff quality.