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27.03.2024 | Originalarbeit

Are bursal-sided supraspinatus tendon lesions caused by subacromial impingement?

A radiological matched-pair analysis

verfasst von: Sebastian Fromm, Dr. med. Sven Lichtenberg, MD, Prof. Dr. med. Markus Loew, MD PhD, Prof. Dr. med. Peter Habermeyer, MD PhD, Prof. Dr. med. Marc Schnetzke, MD PhD

Erschienen in: Obere Extremität

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Abstract

Background

Mechanical outlet impingement is believed to be a significant factor in the pathogenesis of bursal-sided supraspinatus (SSP) tendon partial tear, a rare and poorly described entity. This relationship has not yet been confirmed.

Objective

We compared the radiological impingement parameters between complete, isolated SSP tears and bursal-sided SSP tears. The study hypothesis was that the impingement parameters in the bursal-sided SSP tear group would be significantly more pronounced.

Materials and methods

In total, 43 patients with bursal-sided SSP tendon partial tear (group 1; n = 43) and 43 patients with complete, isolated SSP tendon tear (group 2; n = 43) were included and matched for age (groups 1 and 2: 58 ± 9 years) and gender (70% male and 30% female patients). Standardized preoperative radiographs (anteroposterior; outlet view) were compared for radiological impingement parameters: critical shoulder angle (CSA), lateral acromial angle (LAA), acromiohumeral index (AHI), acromiohumeral distance (AHD), acromion type according to Bigliani (ATB).

Results

Radiological parameters did not differ significantly between groups: CSA: 36° ± 4° (group 1) and 36° ± 4° (group 2); LAA: 79° ± 6° vs. 80° ± 8°; AHD: 11 mm ± 2 mm vs. 10 mm ± 2 mm. The AHI was 0.7 ± 0.1 for both groups. Furthermore, ATB II was most common in both groups (group 1 = 74%; group 2 = 63%), followed by ATB I (group 1 = 14%; group 2 = 23%) and ATB III (group 1 = 12%; group 2 = 14%; p = 0.443).

Conclusion

We found no difference in radiological impingement parameters between bursal-sided and complete SSP tears and therefore reject the study hypothesis. Mechanical outlet impingement does not seem to play a greater role in the development of bursal-sided lesions compared to complete SSP lesions.

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Neer CS (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. https://doi.org/10.2106/00004623-197254010-00003CrossRefPubMed

Bigliani LU, Levine WN (1997) Current concepts review. Subacromial impingement syndrome. J Bone Joint Surg Am 79(12):79A. https://doi.org/10.2106/00004623-199712000-00012CrossRef

Codman E (1934) Tendinitis of the short rotators. The shoulder rupture of the suprasìnatus tendon and other lesions in or about the subacromial bursa. Thomas Todd, Boston

Harvie P et al (2004) Genetic influences in the aetiology of tears of the rotator cuff. J Bone Joint Surg Br. https://doi.org/10.1302/0301-620x.86b5.14747CrossRefPubMed

Hashimoto T, Nobuhara K, Hamada T (2003) Pathologic evidence of degeneration as a primary cause of rotator cuff tear. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000092974.12414.22CrossRefPubMed

Uhthoff HK, Sano H (1997) Pathology of failure of the rotator cuff tendon. Orthop Clin North Am. https://doi.org/10.1016/S0030-5898(05)70262-5CrossRefPubMed

Yang S et al (2009) Biomechanical analysis of bursal-sided partial thickness rotator cuff tears. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2008.12.011CrossRefPubMed

Yamanaka K, Matsumoto T (1994) The joint side tear of the rotator cuff: a followup study by arthrography. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-199407000-00012CrossRefPubMed

Lo IK, Denkers MR, More KD, Nelson AA, Thornton GM, Boorman RS (2018) Partial-thickness rotator cuff tears: clinical and imaging outcomes and prognostic factors of successful nonoperative treatment. Open Access J Sports Med. https://doi.org/10.2147/oajsm.s153236CrossRefPubMedPubMedCentral

10.

Ranebo MC, Björnsson Hallgren HC, Norlin R, Adolfsson LE (2017) Clinical and structural outcome 22 years after acromioplasty without tendon repair in patients with subacromial pain and cuff tears. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2016.11.012CrossRefPubMed

11.

Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C (2013) Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint? A radiological study of the critical shoulder angle. Bone Joint J. https://doi.org/10.1302/0301-620X.95B7.31028CrossRefPubMed

12.

Banas MP, Miller RJ, Totterman S (1995) Relationship between the lateral acromion angle and rotator cuff disease. J Shoulder Elbow Surg. https://doi.org/10.1016/S1058-2746(05)80038-2CrossRefPubMed

13.

Nyffeler RW, Werner CML, Sukthankar A, Schmid MR, Gerber C (2006) Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. https://doi.org/10.2106/JBJS.D.03042CrossRefPubMed

14.

Bigliani LU, Morrison DS, April EW (1986) The morphology of the acromion and its relationship to rotator cuff tears. Ortho Trans. https://doi.org/10.7205/milmed.171.10.1035CrossRef

15.

Ames JB, Horan MP, Van der Meijden OAJ, Leake MJ, Millett PJ (2012) Association between acromial index and outcomes following arthroscopic repair of full-thickness rotator cuff tears. J Bone Joint Surg Am. https://doi.org/10.2106/JBJS.K.01500CrossRefPubMed

16.

Balke M, Schmidt C, Dedy N, Banerjee M, Bouillon B, Liem D (2013) Correlation of acromial morphology with impingement syndrome and rotator cuff tears. Acta Orthop. https://doi.org/10.3109/17453674.2013.773413CrossRefPubMedPubMedCentral

17.

Nicholson GP, Goodman DA, Flatow EL, Bigliani LU (1996) The acromion: morphologic condition and age-related changes. A study of 420 scapulas. J Shoulder Elbow Surg. https://doi.org/10.1016/S1058-2746(96)80024-3CrossRefPubMed

18.

Kaur R, Dahuja A, Garg S, Bansal K, Garg RS, Singh P (2019) Correlation of acromial morphology in association with rotator cuff tear: a retrospective study. Pol J Radiol. https://doi.org/10.5114/pjr.2019.90277CrossRefPubMedPubMedCentral

19.

Pandey V et al (2016) Does scapular morphology affect the integrity of the rotator cuff? J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2015.09.016CrossRefPubMed

20.

Blonna D et al (2016) Predominance of the critical shoulder angle in the pathogenesis of degenerative diseases of the shoulder. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2015.11.059CrossRefPubMed

21.

Chalmers PN, Salazar D, Steger-May K, Chamberlain AM, Yamaguchi K, Keener JD (2017) Does the critical shoulder angle correlate with rotator cuff tear progression? Clin Orthop Relat Res. https://doi.org/10.1007/s11999-017-5249-1CrossRefPubMedPubMedCentral

22.

Cherchi L, Ciornohac JF, Godet J, Clavert P, Kempf JF (2016) Critical shoulder angle: measurement reproducibility and correlation with rotator cuff tendon tears. Orthop Traumatol Surg Res. https://doi.org/10.1016/j.otsr.2016.03.017CrossRefPubMed

23.

Cunningham G, Nicodème-Paulin E, Smith MM, Holzer N, Cass B, Young AA (2018) The greater tuberosity angle: a new predictor for rotator cuff tear. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2018.02.051CrossRefPubMed

24.

Daggett M, Werner B, Collin P, Gauci MO, Chaoui J, Walch G (2015) Correlation between glenoid inclination and critical shoulder angle: a radiographic and computed tomography study. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2015.07.013CrossRefPubMed

25.

Gomide LC, do Carmo TC, Bergo GHM, Oliveira GA, Macedo IS (2017) Relationship between the critical shoulder angle and the development of rotator cuff lesions: a retrospective epidemiological study. Rev Bras Ortop (Sao Paulo). https://doi.org/10.1016/j.rboe.2017.06.002CrossRef

26.

Moor BK, Wieser K, Slankamenac K, Gerber C, Bouaicha S (2014) Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2013.11.008CrossRefPubMed

27.

Shinagawa K et al (2018) Critical shoulder angle in an East Asian population: correlation to the incidence of rotator cuff tear and glenohumeral osteoarthritis. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2018.03.013CrossRefPubMed

28.

Seo J, Heo K, Kwon S, Yoo J (2019) Critical shoulder angle and greater tuberosity angle according to the partial thickness rotator cuff tear patterns. Orthop Traumatol Surg Res. https://doi.org/10.1016/j.otsr.2019.05.005CrossRefPubMed

29.

Spiegl UJ, Horan MP, Smith SW, Ho CP, Millett PJ (2016) The critical shoulder angle is associated with rotator cuff tears and shoulder osteoarthritis and is better assessed with radiographs over MRI. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-015-3587-7CrossRefPubMed

30.

Cotty P et al (1988) Rupture of the rotator cuff. Quantification of indirect signs in standard radiology and the Leclercq maneuver. J Radiol

31.

Neer CS (1983) Impingement lesions. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-198303000-00010CrossRefPubMed

32.

Weiner DS, Macnab I (1970) Superior migration of the humeral head. J Bone Joint Surg Br 52(3):524–527. https://doi.org/10.1302/0301-620X.52B3.524CrossRefPubMed

33.

Nové-Josserand L, Boulahia A, Levigne C, Noel E, Walch G (1999) Espace coraco-humeral et rupture de la coiffe des rotateurs de l’epaule. Rev Chir Orthop Reparatrice Appar Mot. https://doi.org/10.1016/b978-2-294-71318-7.00020-4CrossRefPubMed

34.

Kum DH, Kim JH, Park KM, Lee ES, Park YB, Yoo JC (2017) Acromion index in korean population and its relationship with rotator cuff tears. Clin Orthop Surg. https://doi.org/10.4055/cios.2017.9.2.218CrossRefPubMedPubMedCentral

35.

Saupe N, Pfirrmann CWA, Schmid MR, Jost B, Werner CML, Zanetti M (2006) Association between rotator cuff abnormalities and reduced acromiohumeral distance. AJR Am J Roentgenol. https://doi.org/10.2214/AJR.05.0435CrossRefPubMed

36.

McCreesh KM, Crotty JM, Lewis JS (2015) Acromiohumeral distance measurement in rotator cuff tendinopathy: Is there a reliable, clinically applicable method? A systematic review. Br J Sports Med. https://doi.org/10.1136/bjsports-2012-092063CrossRefPubMed

37.

Singleton N, Agius L, Andrews S (2017) The acromiohumeral centre edge angle: a new radiographic measurement and its association with rotator cuff pathology. J Orthop Surg. https://doi.org/10.1177/2309499017727950CrossRef

38.

Tétreault P, Krueger A, Zurakowski D, Gerber C (2004) Glenoid version and rotator cuff tears. J Orthop Res 22(1):202–207. https://doi.org/10.1016/S0736-0266(03)00116-5CrossRefPubMed

39.

Kim JR, Ryu KJ, Hong IT, Kim BK, Kim JH (2012) Can a high acromion index predict rotator cuff tears? Int Orthop. https://doi.org/10.1007/s00264-012-1499-4CrossRefPubMedPubMedCentral

40.

Miyazaki AN et al (2011) Comparison between the acromion index and rotator cuff tears in the Brazilian and Japanese populations. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2011.04.028CrossRefPubMed

41.

Torrens C, López JM, Puente I, Cáceres E (2007) The influence of the acromial coverage index in rotator cuff tears. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2006.07.006CrossRefPubMed

42.

Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C (2008) The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Joint Surg Am. https://doi.org/10.2106/JBJS.G.00677CrossRefPubMed

43.

Hamid N, Omid R, Yamaguchi K, Steger-May K, Stobbs G, Keener JD (2012) Relationship of radiographic acromial characteristics and rotator cuff disease: a prospective investigation of clinical, radiographic, and sonographic findings. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2011.09.028CrossRefPubMedPubMedCentral

44.

Lin CL, Chen YW, Lin LF, Chen CP, Liou TH, Huang SW (2020) Accuracy of the critical shoulder angle for predicting rotator cuff tears in patients with nontraumatic shoulder pain. Orthop J Sports Med. https://doi.org/10.1177/2325967120918995CrossRefPubMedPubMedCentral

45.

Balke M, Liem D, Greshake O, Hoeher J, Bouillon B, Banerjee M (2016) Differences in acromial morphology of shoulders in patients with degenerative and traumatic supraspinatus tendon tears. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-014-3499-yCrossRefPubMed

46.

Hyvönen P, Lohi S, Jalovaara P (1998) Open acromioplasty does not prevent the progression of an impingement syndrome to a tear. Nine-year follow-up of 96 cases. J Bone Joint Surg Br. https://doi.org/10.1302/0301-620X.80B5.8533CrossRefPubMed

47.

Bond EC et al (2017) The role of acromioplasty when repairing rotator cuff tears—no difference in pain or functional outcome at 24 months in a cohort of 2,441 patients. N Z Med J. https://doi.org/10.2106/jbjs.22.01019CrossRefPubMed

48.

Chahal J et al (2012) The role of subacromial decompression in patients undergoing arthroscopic repair of full-thickness tears of the rotator cuff: a systematic review and meta-analysis. Arthroscopy. https://doi.org/10.1016/j.arthro.2011.11.022CrossRefPubMed

49.

Ketola S et al (2009) Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome? A two-year randomised controlled trial. J Bone Joint Surg Br. https://doi.org/10.1302/0301-620X.91B10.22094CrossRefPubMed

50.

Ketola S, Lehtinen J, Elo P, Kortelainen S, Huhtala H, Arnala I (2016) No difference in long-term development of rotator cuff rupture and muscle volumes in impingement patients with or without decompression: a randomized MRI study of 140 patients. Acta Orthop. https://doi.org/10.1080/17453674.2016.1177780CrossRefPubMedPubMedCentral

51.

Kolk A et al (2017) Does acromioplasty result in favorable clinical and radiologic outcomes in the management of chronic subacromial pain syndrome? A double-blinded randomized clinical trial with 9 to 14 years’ follow-up. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2017.03.021CrossRefPubMed

52.

Mardani-Kivi M, Karimi A, Keyhani S, Hashemi-Motlagh K, Saheb-Ekhtiari K (2016) Rotator cuff repair: is there any role for acromioplasty? Phys Sportsmed. https://doi.org/10.1080/00913847.2016.1216717CrossRefPubMed

53.

Paloneva J, Lepola V, Karppinen J, Ylinen J, Äärimaa V, Mattila VM (2015) Declining incidence of acromioplasty in Finland. Acta Orthop. https://doi.org/10.3109/17453674.2014.977703CrossRefPubMedPubMedCentral

54.

Saltychev M, Äärimaa V, Virolainen P, Laimi K (2015) Conservative treatment or surgery for shoulder impingement: systematic review and meta-analysis. Disabil Rehabil. https://doi.org/10.3109/09638288.2014.907364CrossRefPubMed

55.

Shin SJ, Oh JH, Chung SW, Song MH (2012) The efficacy of acromioplasty in the arthroscopic repair of small- to medium-sized rotator cuff tears without acromial spur: prospective comparative study. Arthroscopy. https://doi.org/10.1016/j.arthro.2011.10.016CrossRefPubMed

56.

Cordasco FA, Backer M, Craig EV, Klein D, Warren RF (2002) The partial-thickness rotator cuff tear: is acromioplasty without repair sufficient? Am J Sports Med. https://doi.org/10.1177/03635465020300021801CrossRefPubMed

57.

Ellman H (1990) Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-199005000-00010CrossRefPubMed

58.

Eraghi A (2020) Acromioplasty in the surgical operations of partial-thickness rotator cuff tears: a comprehensive review. J Family Med Prim Care. https://doi.org/10.4103/jfmpc.jfmpc_870_19CrossRefPubMedPubMedCentral

59.

Itoi E, Tabata S (1992) Incomplete rotator cuff tears: results of operative treatment. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-199211000-00016CrossRefPubMed

Titel: Are bursal-sided supraspinatus tendon lesions caused by subacromial impingement?
A radiological matched-pair analysis
verfasst von: Sebastian Fromm
Dr. med. Sven Lichtenberg, MD
Prof. Dr. med. Markus Loew, MD PhD
Prof. Dr. med. Peter Habermeyer, MD PhD
Prof. Dr. med. Marc Schnetzke, MD PhD
Publikationsdatum: 27.03.2024
Verlag: Springer Medizin
Erschienen in: Obere Extremität
Print ISSN: 1862-6599
Elektronische ISSN: 1862-6602
DOI: https://doi.org/10.1007/s11678-024-00795-7

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