Dynamic Three-Dimensional Shoulder Mri during Active Motion for Investigation of Rotator Cuff Diseases

Abstract

BackgroundMRI is the standard methodology in diagnosis of rotator cuff diseases. However, many patients continue to have pain despite treatment, and MRI of a static unloaded shoulder seems insufficient for best diagnosis and treatment. This study evaluated if Dynamic MRI provides novel kinematic data that can be used to improve the understanding, diagnosis and best treatment of rotator cuff diseases.MethodsDynamic MRI provided real-time 3D image series and was used to measure changes in the width of subacromial space, superior-inferior translation and anterior-posterior translation of the humeral head relative to the glenoid during active abduction. These measures were investigated for consistency with the rotator cuff diseases classifications from standard MRI.ResultsThe study included: 4 shoulders with massive rotator cuff tears, 5 shoulders with an isolated full-thickness supraspinatus tear, 5 shoulders with tendinopathy and 6 normal shoulders. A change in the width of subacromial space greater than 4mm differentiated between rotator cuff diseases with tendon tears (massive cuff tears and supraspinatus tear) and without tears (tendinopathy) (p = 0.012). The range of the superior-inferior translation was higher in the massive cuff tears group (6.4mm) than in normals (3.4mm) (p = 0.02). The range of the anterior-posterior translation was higher in the massive cuff tears (9.2 mm) and supraspinatus tear (9.3 mm) shoulders compared to normals (3.5mm) and tendinopathy (4.8mm) shoulders (p = 0.05).ConclusionThe Dynamic MRI enabled a novel measure; ‘Looseness’, i.e. the translation of the humeral head on the glenoid during an abduction cycle. Looseness was better able at differentiating different forms of rotator cuff disease than a simple static measure of relative glenohumeral position.

Relationship Between Deltoid and Rotator Cuff Muscles During Dynamic Shoulder Abduction: A Biomechanical Study of Rotator Cuff Tear Progression

“…15,16 Dynamic magnetic resonance imaging of shoulders with and without cuff tears has been able to correlate the degree of humeral head translation with the extent of RTC tears. 20 As tears extend posteriorly, the loss of balanced concavitycompression and superior contact point translation disrupt the mechanical advantage of the deltoid, which results in greater forces required to maintain joint stability. 15,21 Currently, there is limited study regarding what biomechanical effect RTC tears have on deltoid forces during dynamic glenohumeral abduction.…”

Dynamic MRI to quantify musculoskeletal motion: A systematic review of concurrent validity and reliability, and perspectives for evaluation of musculoskeletal disorders

“…Since the clinical evaluation of functional joint kinematics using dynamic MRI techniques is likely to expand (diagnosis, pre-operative planning, rehabilitation and clinical follow-up), it is necessary to assess the metrological evidence of the techniques used. Dynamic MRI techniques have been used to evaluate joint kinematics in the case of disorders of the knee joint [ 50 – 54 ], the wrist joint [ 37 ], the TMJ [ 47 ], the shoulder joint [ 55 ], and the spine [ 56 – 60 ]. However, no one dynamic MRI technique has been evaluated for concurrent validity and reliability for all joints.…”

“…Thus, the role of dynamic MRI for the diagnosis of challenging cases is currently uncertain, and this technique is at an early stage of development. At the very best, dynamic MRI techniques can be used in the research setting to answer clinically important research questions such as understanding pain mechanisms [ 88 ] or evaluating functional anatomy [ 55 , 71 ] etc. Nevertheless, the results of this study regarding the validity and reliability of dynamic MRI techniques for the assessment of the musculoskeletal system are encouraging.…”

Protocol for a randomised controlled trial of Subacromial spacer for Tears Affecting Rotator cuff Tendons: a Randomised, Efficient, Adaptive Clinical Trial in Surgery (START:REACTS)

“…The primary outcome will be the minimum acromiohumeral distance on the 'deltoid-active' coronal sequences at 6 months, a reliable and proven measure. [55][56][57] The balloon is expected to have deflated by 6 months. 58 Secondary measures will be acromiohumeral distance on passive images, and the change in acromio-humeral distance between active and passive images.…”