Radiographic Signs Predicting Rotator Cuff Tears Poster No.: P-0051 Congress: ESSR 2015 Type: Scientific Poster Authors: J. J. van der Reijden, M. van den Bekerom, M. Somford, J. 1 2 2 4 1 3 2 Doornberg, M. van den Borne ; Deventer/NL, Amsterdam/NL, 3 4 Zwolle/NL, Breda/NL Keywords: Musculoskeletal soft tissue, Plain radiographic studies, Diagnostic procedure, Outcomes DOI: 10.1594/essr2015/P-0051 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.essr.org Page 1 of 10
Purpose Conventional radiography is regarded to have little predictive value for the presence of a rotator cuff tear. Ultrasonography / MRI is essential for the final diagnosis, radiography could complement the decisional proces. Conventional radiography is easy accessable and less depending on patient or doctor. Various radiographic markers and techniques have been reported to have a possible predictive value for the presence of rotator cuff tears. The purpose of this study is to evaluate the diagnostic accuracy of plain radiographs to predict the presence of a rotator cuff tear. Conventional radiography could become a more valuable tool in predicting the presence of rotator cuff tears. Images for this section: Page 2 of 10
Fig. 1: Demonstrating the normal anatomy of the rotator cuff muscles. Fig. 2: Demonstrating the normal anatomy of the rotator cuff muscles. Page 3 of 10
Methods and Materials A consecutive series of 236 patients where a shoulder arthroscopy for any reason has been performed. Online based research, www.shoulderelbowplatform.org. Two observers assesed the following markers on pre-operative radiographs: Subacromial sclerosis Superior migration of the humeral head A lateral acromial spur Cyst(s) in the greater tubercle Calcifications in the rotator cuff trajectory Three groups. 1. 2. 3. Full thickness rotator cuff tear Partial thickness rotator cuff tear No rotator cuff tear Analysis of the following: Men Sensitivity, specificity, positive predictive value, negative predictive value and prevalence. FTRC TEAR PRC TEAR No RC TEAR Total 64 50 10 8 54 42 128 Mean 61 age men (years) Women 47 Mean age women (years) 60 53 44 10 60 46 9 51 47 53 47 108 56 Images for this section: Page 4 of 10
Fig. 3: Demonstrating superior migration of the humeral head. Page 5 of 10
Fig. 4: Demonstrating all markers with type C calcifications (heterogeneous appearance with #uffy deposit). Page 6 of 10
Fig. 5: Demonstrating the web-based questionnaire and DICOM viewer. Page 7 of 10
Results Prevelance of a rotator cuff tear: 56 in a group of 236 patients. True positives per diagnosed marker. Diagnosed RC tear on arthroscopy SA sclerosis 93 39 72 77 Lateral spur 39 17 37 95 Superior migration 26 11 21 81 Cysts 7 3 7 100 Calcification 38 16 15 39 Results per marker. Sensitivity Specificity Accuracy PPV NPV RC tear Sub acromial sclerosis 55 80 66 78 58 Lateral Acromial Spur 28 98 59 95 52 Superior Migration 16 95 51 80 47 Cyst 5 100 47 99 46 78 41 39 59 Calcifications 11 Conclusion For the diagnosis of a rotator cuff tear, the following markers could be used: 1. 2. 3. Presence of a lateral acromial spur. Superior migration of the humeral head. Cysts in the greater tubercle. Page 8 of 10
Advantage: extra tool for diagnosing rotator cuff tears. More information can be extracted from conventional radiography then originally thought. Next step: 1. 2. Reaching a large group of observers to minimalize interobserver variability. Adding the possibility to perform measurements within the DICOM viewer. References 1. 2. 3. 4. Balke M, Schmidt C, Dedy N, Banerjee M, Bouillon B, Liem D. Correlation of acromial morphology with impingement syndrome and rotator cuff tears. Acta Orthop. 2013;84(2):178-183. Hamid N, Omid R, Yamaguchi K, Steger-May K, Stobbs G, Keener JD. Relationship of radiographic acromial characteristics and rotator cuff disease: A prospective investigation of clinical, radiographic, and sonographic findings. J Shoulder Elbow Surg. 2012;21(10):1289-1298. Nyffeler RW, Werner CM, Sukthankar A, Schmid MR, Gerber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. 2006;88(4):800-805. Umans HR, Pavlov H, Berkowitz M, Warren RF. Correlation of radiographic and arthroscopic findings with rotator cuff tears and degenerative joint disease. J Shoulder Elbow Surg. 2001;10(5):428-433. Personal Information Jeroen van der Reijden, MD is a first year Radiology resident working in the Deventer Hospital in Deventer. Michel van den Bekerom, MD is an orthopaedic surgeon working in the Onze Lieve Vrouwe Gasthuis in Amsterdam. Matthijs Somford, MD is an orthopaedic surgeon working in the Martini Hospital in Groningen. Job Doornberg, MD PhD is a final year resident orthopaedic surgery in the Academic Medical Center in Amsterdam. Page 9 of 10
Maaike van den Borne, MD is an orthopaedic surgeon working in the Amphia Hospital in Breda. All of the researchers are working in The Netherlands. Page 10 of 10