Accuracy of sagittal oblique view in preoperative indirect magnetic resonance arthrography for diagnosis of tears involving the upper third of the subscapularis tendon

Ryu, Ho Young; Song, Seung Yeop; Yoo, Jae Chul; Yun, Ji Young; Yoon, Young Chul

doi:10.1016/j.jse.2016.02.038

Cited by 18 publications

(16 citation statements)

References 21 publications

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“…This can be explained by the difficulty in differentiating partial tears from tendinopathy, as reported by other authors. 26,28 To our knowledge, the present study is the first to calculate intra-observer agreement in relation to detection of subscapularis tears by means of MRI.…”

Section: Discussionmentioning

confidence: 87%

Diagnostic accuracy of preoperative magnetic resonance imaging for detecting subscapularis tendon tears: a diagnostic test study

Ramadan¹,

Baptista

Souza³

et al. 2020

Sao Paulo Med. J.

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Although the biomechanical importance of the subscapularis tendon has been recognized in biomechanical 1 and clinical studies, 2 it has long received little attention in the medical literature, 3 and has been called the "forgotten tendon". 4 Only 1% of rotator cuff tears affect only the subscapularis, 5,6 but more than half of all patients with supraspinatus tears present an associated tear of this tendon. 7,8 The accuracy of magnetic resonance imaging (MRI) is usually lower for detection of subscapularis tears than for rotator cuff tears overall, 9,10 with sensitivity ranging from 25% to 94% 5,11 and specificity from 67% to 100%. [12][13][14] Studies evaluating the diagnosis of subscapularis tears are important for clinical practice, with implications for prognosis and surgical planning. Among the published studies, some have included low magnetic field MRI, 7,13,15,16 small samples, 15,17 diagnosis not restricted to rotator cuff disorders, 7,12,14-16,18-21 and use of intra-articular 11,14,19 or intravenous 15,20 contrast. These factors can generate bias in data interpretation. OBJECTIVEThe objective of the present study was to evaluate the accuracy of preoperative high magnetic field MRI without the use of contrast, compared with arthroscopic inspection, for identifying subscapularis tears, in cases undergoing rotator cuff repair. METHODSThis was a diagnostic test study comparing the findings from preoperative MRI (index test) with those from shoulder arthroscopy (reference standard) for diagnosing subscapularis tears.Operative data were collected in a standardized manner from consecutive patients between January 2013 and August 2017, by three surgeons at the same institution.

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Section: Discussionmentioning

confidence: 87%

Diagnostic accuracy of preoperative magnetic resonance imaging for detecting subscapularis tendon tears: a diagnostic test study

Ramadan¹,

Baptista

Souza³

et al. 2020

Sao Paulo Med. J.

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“…Most SSC tendon tears start as disinsertion of the superior border of the tendon ▶ and extend inferiorly [15]. This might be the reason for the higher rates for accuracy reported by Ryu et al using a sagittal oblique technique, with a sensitivity, specificity, and accuracy of SSC tendon tear detection of 0.72, 0.77, and 0.75, respectively, for the radiologists [16]. Additionally, radial slice magnetic resonance images reached sensitivity values of 94.7 % and a specificity of 82.4 % and were promoted as useful for diagnosing these lesions.…”

Section: Discussionmentioning

confidence: 99%

Subscapularis Tendon Tears – Usefulness of Written MRI Reports for Guiding Patient Referral to Shoulder Specialists

Lenz¹,

Kircher²,

Schwalba³

et al. 2021

Rofo

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Introduction Rotator cuff tears are one of the most common reasons for shoulder pain, and patients often present initially to general practitioners. However, subscapularis tears are especially difficult to diagnose and hence adequate therapy is often delayed. General practitioners or non-specialist orthopedic surgeons need reliable MRI findings to allow timely referral of patients to shoulder specialists. The purpose of this study was to determine the validity of the written MRI report of patients with arthroscopically proven subscapularis tendon tears. Method In this retrospective study, 97 patients (mean age 62.4 ± 10 years, 63 men) who underwent arthroscopic subscapularis repair between April 2013 and January 2015 by two experienced shoulder surgeons and who underwent a preoperative 1.5 T MRI study were included. All of these patients had high-field strength (i. e., ≥ 1.5 T) standard MRI scans performed within 4–164 (mean 57.4 ± 38.4) days before their arthroscopic procedures. Results and Conclusion Subscapularis tendon tears, verified by arthroscopy, were correctly identified in only 37 of 97 cases in the written report of the preoperative MRI. This resulted in an overall low sensitivity of 38.1 %. Correctly predicted lesions were as follows: Fox and Romeo I 29.4 % (5/17 patients), Fox and Romeo II 20 % (7/35 patients), Fox and Romeo III 46.7 % (14/30 patients) and Fox and Romeo IV 73.3 % (11/15 patients). In contrast, concurrent supraspinatus tendon tears were identified correctly in 88.2 % of patients (60/68 cases, sensitivity 88.2 %, specificity 96.5 %). Preoperative written radiology reports provided by a heterogeneous group of 39 presumably non-MSK-specialized radiologic centers do not reliably detect subscapularis tendon tears and are not sufficient for guiding patients to specialist centers. Compared to other rotator cuff injuries, this study shows difficulties in the correct diagnosis of subscapular tendon injuries. However, this is necessary to provide patients with timely therapy. It can be assumed that MRI review by musculoskeletal-specialized radiologists would more often than not lead to the correct diagnosis. Key Points: Citation Format

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“…We classified the subscapularis tendon tear according to the recently published classification of Yoo et al 26 based on the facet concept, although the classification is based on arthroscopic findings of a subscapularis tendon tear. 18 Through this classification, we wanted to know whether it is possible to create a CIST scoring system based on preoperative MRI findings only. A 5-category grading system was introduced, including the following: grade 0, no tear; grade I, fraying; grade IIA, a partial tear ≤50% of the first facet; grade IIB, a partial tear >50% of the first facet; grade III, a tear involving the entire first facet, and grade IV, a tear extending to the second facet.…”

Section: Methodsmentioning

confidence: 99%

Hidden Long Head of the Biceps Tendon Instability and Concealed Intratendinous Subscapularis Tears

Chae

Jung

Lee

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Few studies have described the characteristics of a concealed intratendinous subscapularis tear (CIST), and there is a lack of research on the preoperative predictability of such lesions. Purpose: To describe the characteristics of a CIST as seen on magnetic resonance imaging (MRI) and intraoperatively and to develop a scoring system for predicting such lesions. Study Design: Case series; Level of evidence, 4. Methods: Retrospectively, we identified 43 patients with CISTs among 442 consecutive patients who had undergone rotator cuff repair from July 2014 to June 2016. Range of motion, visual analog scale results for pain and function, and patient-reported outcome scores were evaluated preoperatively and at 1 and 2 years postoperatively. CISTs were classified arthroscopically as small (<5 mm), medium (5-10 mm), and large (>10 mm). We performed repair (≥50%) or debridement (<50%) depending on the total subscapularis tendon tear size including the CIST. Preoperative MRI findings were analyzed by 2 observers and were correlated with the arthroscopic findings. A 10-point scoring system was developed based on characteristics during the physical examination (anterior tenderness, bear hug sign), MRI (biceps tendon displacement and subluxation, subscapularis signal change just lateral to the lesser tuberosity), and arthroscopic surgery (medial biceps tendon lesion, combined subscapularis tendon tear), with a cutoff value of ≥7 predicting a CIST. After the retrospective study, we prospectively enrolled 95 patients to validate the 10-point CIST scoring system. Results: All 43 patients diagnosed with a CIST during the retrospective study improved both range of motion and functional scores at 1 year postoperatively. The interrater agreement of the 2 observers was substantial for the evaluation of all parameters except for subscapularis tear classification, which was moderate. On arthroscopic surgery, 11 small, 19 medium, and 13 large CISTs were detected. The preliminary prospective study showed a sensitivity of 61.9%, specificity of 94.3%, positive predictive value of 89.0%, negative predictive value of 75.7%, and accuracy of 80.0% when the cutoff value was set at ≥7 on the CIST scoring system. Conclusion: A CIST can be suspected using a combination of preoperative MRI and intra-articular diagnostic arthroscopic findings, but a definitive diagnosis requires an arthroscopic view. On the 10-point CIST scoring system, a score of ≥5 can be suggestive of a CIST, and a score of ≥7 is most likely to predict a CIST.

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Accuracy of sagittal oblique view in preoperative indirect magnetic resonance arthrography for diagnosis of tears involving the upper third of the subscapularis tendon

Cited by 18 publications

References 21 publications

Diagnostic accuracy of preoperative magnetic resonance imaging for detecting subscapularis tendon tears: a diagnostic test study

Diagnostic accuracy of preoperative magnetic resonance imaging for detecting subscapularis tendon tears: a diagnostic test study

Subscapularis Tendon Tears – Usefulness of Written MRI Reports for Guiding Patient Referral to Shoulder Specialists

Hidden Long Head of the Biceps Tendon Instability and Concealed Intratendinous Subscapularis Tears

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