Complications of rotator cuff surgery—the role of post-operative imaging in patient care

Abstract

When pain or disability occurs after rotator cuff surgery, post-operative imaging is frequently performed. Post-operative complications and expected post-operative imaging findings in the shoulder are presented, with a focus on MRI, MR arthrography (MRA) and CT arthrography. MR and CT techniques are available to reduce image degradation secondary to surgical distortions of native anatomy and implant-related artefacts and to define complications after rotator cuff surgery. A useful approach to image the shoulder after surgery is the standard radiography, followed by MRI/MRA for patients with low "metal presence" and CT for patients who have a higher metal presence. However, for the assessment of patients who have undergone surgery for rotator cuff injuries, imaging findings should always be correlated with the clinical presentation because post-operative imaging abnormalities do not necessarily correlate with symptoms.The complexity of the anatomy and function of the rotator cuff makes the rotator cuff tendons vulnerable to considerable morbidity, often necessitating surgical intervention. Optimal management of rotator cuff abnormalities depends on a variety of factors, such as the presence and severity of an impingement, the degree of tendon damage and individual functional demands.1 The goals of rotator cuff surgery are to reduce pain, while simultaneously improving the function. The latter is accomplished by two main types of surgical procedures: (1) subacromial decompression surgery alone, typically with an acromioplasty and/or Mumford procedure (distal clavicular resection); and (2) repair of the rotator cuff tear (open or arthroscopic), which is almost always accompanied by a subacromial decompression.Post-operative imaging is performed when pain or disability occurs after a surgical procedure. Often, however, postoperative imaging is degraded by surgical distortions of the native anatomy and metallic artefacts related to implants. Nevertheless, it is imperative that clinicians have an accurate anatomical delineation of the operative site. It is also important for the radiologist to accurately diagnose complications that might occur after rotator cuff surgery to guide optimal treatment. Mansat et al 2 examined 40 articles reporting the results of open rotator cuff repairs and determined that the overall mean complication rate was 10.5%.The article addresses complications that occur after rotator cuff surgery and expected post-operative imaging findings, with a focus on MRI, MR arthrography (MRA) and CT arthrography (CTA). Because not all post-operative imaging findings result in disability or pain for the patient, we also emphasize our approach and experience regarding how best to define imaging abnormalities after rotator cuff surgery. IMAGING APPROACHA protocol for the imaging of the post-operative shoulder always begins with radiography of the shoulder. The purpose of the radiograph is not only to detect obvious osseous complications, but also to identify the type of surgical procedure performed ...

Advances in MRI around metal

“…MARS imaging can successfully be performed at the shoulder . However, since the shoulder is not located in the isocenter of the main magnetic field but peripherally with a more inhomogeneous magnetic field, severe inhomogeneity artifacts are encountered .…”

The Repaired Rotator Cuff: MRI and Ultrasound Evaluation

“…6a-d) [5,30]. If displaced into the glenohumeral joint, suture anchors can also cause a locking sensation of the shoulder [4,5]. One case study found a suture anchor displaced into the acromioclavicular joint [29].…”

“…In the symptomatic patient after rotator cuff repair, the primary etiologies to consider include, but are not limited to, rotator cuff re-tear, impingement, and postoperative synovitis. Hardware dislodgement can also be an unexpected finding on imaging, which may cause significant pain and impairment [4,5].…”

“…The risk of re-tear increases with patient age [6] and size of the preoperative rotator cuff tear [7]. Additional risk factors associated with re-tears include preoperative fatty infiltration of the rotator cuff musculature [4] and double-row repairs [8]. Magnetic resonance imaging (MRI) and ultrasound (US) are both used in evaluating pathology after rotator cuff repair.…”

Musculotendinous Disorders in the Upper Extremity: Part 1. MRI of the Shoulder and Upper Arm

“…11). 25 Partial and complete tearing of the proximal deltoid muscle may also occur in patients with chronic large rotator cuff tears related to attrition from spurring and hypertrophy of the greater tuberosity (►Fig. 12).…”