Association between the location of tuberosity cysts and rotator cuff tears: A comparative study using radiograph and MRI

Gwark, Ji-Yong; Park, Tae‐Soo; Park, Hyung Bin

doi:10.1177/2309499019825762

Cited by 7 publications

(13 citation statements)

References 25 publications

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“…Degenerative changes on a shoulder radiograph have been shown to indicate fatty infiltration and atrophic changes in rotator cuff muscles. 5 , 13 In the present study, we found that radiographic signs, including GT spur formation, acromial spur formation, and narrow AHI, were associated with the stage of supraspinatus retraction. The combinations of these radiographic signs were highly specific and accurate in terms of predicting advanced retraction of the supraspinatus tendon.…”

Section: Discussionsupporting

confidence: 53%

“…Radiographic GT spur and GT sclerosis indicate symptomatic rotator cuff tears 24 and large-sized tears. 18 Cyst formation in the anterior GT 13 and a GT angle greater than 70 degrees 6 have been found to be related to the incidence of rotator cuff tears as well. The combination of these radiographic degenerative signs is effective in ruling out rotator cuff tears when assessed by senior practitioners, 3 with the combined sensitivity and negative predictive value being 91.7% and 80%, respectively.…”

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confidence: 99%

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Radiographic greater tuberosity spurs and narrow acromiohumeral intervals are associated with advanced retraction of the supraspinatus tendon in patients with symptomatic rotator cuff tears

Chuang¹,

Hong²,

Hsu³

et al. 2021

JSES International

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Background Degenerative signs on shoulder radiographs, including spur formation and narrow acromiohumeral intervals (AHIs), have been recognized as indicative of atrophic and fat-infiltrated rotator cuff muscles. Past studies have demonstrated that patients with poor quality muscles are prone to retraction of the supraspinatus tendon and failure to repair. However, the association between radiographic signs and tendon retraction has never been elucidated in previous literature. The present study aimed to investigate the association between the degenerative signs on shoulder radiographs and the severity of supraspinatus retraction. Methods Images of 67 individuals, who had undergone an arthroscopic rotator cuff repair, were retrospectively reviewed. The greater tuberosity (GT) morphology, subacromial spur, AHI, and acromial thickness were evaluated on the radiographs, whereas the retraction of the supraspinatus tendon was assessed via an MRI in accordance with the Patte classification. Simple regression analyses between the radiographic signs and Patte stages were performed, and factors reaching statistical significance were then included in the multiple ordinal logistic regression. Statistically significant predictors from the multiple regression analysis were constructed into combinations, for which the sensitivity and specificity were calculated. Results The GT morphology ( P = .004), AHI ( P = .083), subacromial spur ( P = .008), and age ( P = .004) were associated with supraspinatus retraction in the simple regression analyses. These four parameters were incorporated into the multiple ordinal logistic regression, where the GT spur (adjusted odds ratio 8.63, 95% confidence interval 2.16-34.53, P = .002) and AHI (AOR 0.79, 95% CI 0.63-0.98, P = .032) were demonstrated to be predictive of the Patte stage of supraspinatus retraction. The acromial spur implied a higher risk of severe retraction although this finding was not statistically significant (AOR 2.89, 95% CI 0.90-9.29, P = .075). The presence of concurrent GT spur and narrow AHI was highly specific (sensitivity 27.3% / specificity 91.1%) for advanced supraspinatus retraction. Conclusion The presence of a radiographic GT spur, narrow AHI, and subacromial spur indicated advanced retraction of the supraspinatus tendon. When patients with clinical suspicion of rotator cuff tear present with combinations of these radiographic signs, a prompt MRI examination and a referral to a shoulder specialist are recommended.

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Section: Discussionsupporting

confidence: 53%

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confidence: 99%

Radiographic greater tuberosity spurs and narrow acromiohumeral intervals are associated with advanced retraction of the supraspinatus tendon in patients with symptomatic rotator cuff tears

Chuang¹,

Hong²,

Hsu³

et al. 2021

JSES International

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“…Subcortical cystic changes of the humeral tuberosities (shown in Figures 1-4 ) have an incidence of 15% to 45% in asymptomatic shoulders, with an association with ageing and rotator cuff pathology ( 2 ). They may be further divided based on location, into bare-area, lesser tuberosity, anterior greater tuberosity and posterior greater tuberosity cysts ( 2 , 7 ).…”

Section: Differential Diagnosismentioning

confidence: 99%

“…On MRI, subcortical cysts are seen at the tuberosities and bare area of the humerus as round lesions with low T1 and high T2 signal. These should be differentiated from vascular channels which are connected to tubular structures ( 2 ).…”

Section: Differential Diagnosismentioning

confidence: 99%

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Cystic lesions of the humeral head on magnetic resonance imaging: a pictorial review

Mangi

Zadow

Lim

2022

Quant Imaging Med Surg

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Cystic lesions of the humeral head are commonly encountered on routine shoulder magnetic resonance imaging (MRI). Differential diagnoses include degenerative lesions, calcific tendinitis with osseous involvement, perianchor cysts, abscesses and less often, tumours. Degenerative lesions, including subcortical and subchondral cysts, are the most commonly encountered. These may be associated with rotator cuff disease and degenerative joint diseases or considered part of ageing depending on the location of the cystic lesions. For instance, cysts of the bare area of the humeral head are considered benign age-related entities, whereas cysts of the greater or lesser tuberosity may herald rotator cuff disease. Infectious lesions, particularly osteomyelitis and intraosseous (Brodie’s) abscesses, are intramedullary in location and should be suspected in the context of clinical features such as fever and radiological features such as the penumbra sign. Perianchor cysts are postoperative lesions associated with the use of suture anchors in surgeries such as rotator cuff tear repairs. They generally self-resolve over 18 to 24 months. On MRI, the distribution, morphology, and signal characteristics can help point towards a specific diagnosis. The patient’s demographic, clinical presentation, and past surgical history can be discriminatory. Knowledge of different cystic lesions in the humeral head and underlying aetiology can be useful in helping the radiologist develop a more thorough search pattern for associated conditions. Determining the underlying cause of cysts can have important implications on management, such as when differentiating perianchor cysts from infection. This pictorial review outlines the differential diagnoses of humeral head cysts on MRI and provides a diagnostic approach for the radiologist.

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Periimplant osteolysis does not affect the outcome of rotator cuff repair: a systematic review and meta-analysis

Lee

Cheon

Seo

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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PurposeThe goal of this study was to perform a systematic review and meta‐analysis to compare the clinical and radiologic outcomes of rotator cuff repair, depending on the presence of developed periimplant osteolysis (PIO) after using suture anchors. MethodsThe electronic databases of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for articles published up until October 2019 to find relevant articles comparing the outcomes of rotator cuff repair between the periimplant osteolysis group and non‐periimplant osteolysis group. Data searching, extraction, analysis, and quality assessment were performed according to the Cochrane Collaboration guidelines. The results are presented as risk ratio (RR) for binary outcomes and standardised mean difference (SMD) for continuous outcomes with 95% confidence intervals (CI). ResultsSix clinical studies were included. No significant differences were found between the group with periimplant osteolysis and the group without periimplant osteolysis regarding retear rate (RR = 1.34; 95% CI 0.93–1.94; I2 = 28%), postoperative clinical scores (SMD = 0.29; 95% CI − 0.26 to 0.83; I2 = 80%) and range of motion (ROM); forward flexion (SMD = 0.39; 95% CI − 0.16 to 0.93; I2 = 0%), external rotation (SMD = − 0.10; 95% CI − 0.64 to 0.45; I2 = 0%) and internal rotation (SMD = − 0.37; 95% CI − 0.92 to 0.17; I2 = 0%). ConclusionThe presence of periimplant osteolysis after rotator cuff repair with suture anchor does not affect the clinical outcomes such as retear rate, clinical scoring, and ROM. However, as there was no standard consensus on the criteria for evaluating periimplant osteolysis, this result may not fully reflect the effect of periimplant osteolysis depending on its severity. Level of evidenceLevel IV.

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Association between the location of tuberosity cysts and rotator cuff tears: A comparative study using radiograph and MRI

Cited by 7 publications

References 25 publications

Radiographic greater tuberosity spurs and narrow acromiohumeral intervals are associated with advanced retraction of the supraspinatus tendon in patients with symptomatic rotator cuff tears

Radiographic greater tuberosity spurs and narrow acromiohumeral intervals are associated with advanced retraction of the supraspinatus tendon in patients with symptomatic rotator cuff tears

Cystic lesions of the humeral head on magnetic resonance imaging: a pictorial review

Periimplant osteolysis does not affect the outcome of rotator cuff repair: a systematic review and meta-analysis

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