The critical shoulder angle (CSA) in glenohumeral osteoarthritis: Does observer experience affect measurement reliability on plain radiographs?

Saks, Benjamin R.; Holtzman, Ari J.; Tabeayo, Eloy; Cuomo, Frances; Gruson, Konrad I.

doi:10.1016/j.jor.2020.04.004

Cited by 8 publications

(5 citation statements)

References 19 publications

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“…In fact, the CSA can be reliably measured by examiners at varying levels of orthopaedic training, even in patients with more advanced radiographic glenohumeral OA. 29 Nevertheless, our study group did not include patients ≥50 years of age, at which point the prevalence of shoulder OA begins to increase. 18 We used 25 years as the lower age limit to ensure complete fusion of the secondary ossification centers of the glenoid and distal acromion.…”

Section: Discussionmentioning

confidence: 99%

Optimization of the Grashey View Radiograph for Critical Shoulder Angle Measurement: A Reliability Assessment With Zero Echo Time MRI

Yıldız

Yaraşır

Huri

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Suboptimal positioning on Grashey view radiographs may limit the prognosticating potential of the critical shoulder angle (CSA) for shoulder disorders. Purpose: To investigate whether radiography optimized according to the latest research is reliable for measuring CSA in comparison with magnetic resonance imaging (MRI) featuring 3-dimensional (3D) zero echo time (ZTE) sequencing, which accentuates the contrast between cortical bone and surrounding soft tissue with high fidelity. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients with shoulder pain were prospectively and consecutively enrolled. All patients had Grashey view radiographs as well as 3.0-T MRI scans with isotropic 3D ZTE sequencing. Acceptable positioning on the radiographs was determined using the ratio of the transverse to longitudinal (RTL) diameter of the lateral glenoid outline; radiographs with an RTL ≥0.25 were repeated. Two observers independently measured the CSA on the radiographs and the coronal oblique reformatted ZTE images, the latter including verification of measurement points by cross-referencing against images from other planes. Reliability of measurements between observers and modalities was analyzed with the intraclass correlation coefficient (ICC). The paired-samples t test was used to compare the differences between imaging modalities. Results: Enrolled were 65 patients (35 female and 30 male; mean age, 40.2 years; range, 25-49 years). Radiographs with optimal positioning (RTL < 0.25) were attained after a mean of 1.6 exposures (range, 1-4); the mean RTL was 0.09 (range, 0-0.20). Interobserver agreement of CSA was excellent for radiographs (ICC = 0.91; 95% CI, 0.84-0.94) and good for ZTE MRI scans (ICC = 0.85; 95% CI, 0.71-0.92). Intermodality agreement of CSA between radiographs and ZTE MRI scans was moderate (ICC = 0.66; 95% CI, 0.48-0.73). The CSA was significantly different between an optimal radiograph (30.7° ± 4.3°) and ZTE MRI scan (31.8° ± 3.8) ( P = .005). Subgroup analysis revealed no significant differences in CSA measurement between ZTE MRI scans and Grashey view radiographs with an RTL of <0.1 ( P = .08). Conclusion: CSA measurement on ZTE MRI scans with anatomic point cross-referencing was significantly different from that on Grashey view radiographs, even with optimal positioning, and radiography may necessitate more than 1 exposure. An RTL of <0.1 ensured reliability of radiographs when other standards of sufficient x-ray exposure were met.

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Section: Discussionmentioning

confidence: 99%

Optimization of the Grashey View Radiograph for Critical Shoulder Angle Measurement: A Reliability Assessment With Zero Echo Time MRI

Yıldız

Yaraşır

Huri

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…When the radiograph was not affected by rotation and overlapping of the anterior and posterior edges of the glenoid cavity, we defined it as having sufficient image quality for CSA assessment. Based on a previous study, the inter- and intra-observer reliability for measuring the CSA was excellent [ 30 ]. CSA was measured from the angle made by the superior and inferior bony margins of the glenoid and a line from the inferior bony margin of the glenoid to the most lateral border of the acromion ( Figure 1 A).…”

Section: Methodsmentioning

confidence: 99%

Accuracy of Critical Shoulder Angle and Acromial Index for Predicting Supraspinatus Tendinopathy

Hsu

Lin

et al. 2022

Diagnostics

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Critical shoulder angle (CSA) is the angle between the superior and inferior bony margins of the glenoid and the most lateral border of the acromion. The acromial index (AI) is the distance from the glenoid plane to the acromial lateral border and is divided by the distance from the glenoid plane to the lateral aspect of the humeral head. Although both are used for predicting shoulder diseases, research on their accuracy in predicting supraspinatus tendinopathy in patients with shoulder pain is limited. Data were retrospectively collected from 308 patients with supraspinatus tendinopathy between January 2018 and December 2019. Simultaneously, we gathered the data of 300 patients with shoulder pain without supraspinatus tendinopathy, confirmed through ultrasound examination. Baseline demographic data, CSA, and AI were compared using the independent Student’s t test and Mann–Whitney U test. Categorical variables were analyzed using the chi-square test. A receiver operating characteristic curve (ROC) analysis was performed to investigate the accuracy of CSA and AI for predicting supraspinatus tendinopathy, and the optimal cut-off point was determined using the Youden index. No statistical differences were observed for age, sex, body mass index, evaluated side (dominant), diabetes mellitus, and hyperlipidemia between the groups. The supraspinatus tendinopathy group showed higher CSAs (p < 0.001) than did the non-supraspinatus tendinopathy group. For predicting supraspinatus tendinopathy, the area under the curve (AUC) of ROC curve of the CSA was 76.8%, revealing acceptable discrimination. The AUC of AI was 46.9%, revealing no discrimination. Moreover, when patients with shoulder pain had a CSA > 38.11°, the specificity and sensitivity of CSA in predicting supraspinatus tendinopathy were 71.0% and 71.8%, respectively. CSA could be considered an objective assessment tool to predict supraspinatus tendinopathy in patients with shoulder pain. AI revealed no discrimination in predicting supraspinatus tendinopathy in patients with shoulder pain.

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“…The mean value of these values was obtained for data analysis. Based on a previous study, the inter-and intraobserver reliability for measuring the CSA was excellent, with an intra-class coefficient (ICC) more than 0.9 [21].…”

Section: Radiographic Assessment Of Csamentioning

confidence: 95%

Acromioplasty reduces critical shoulder angle in patients with rotator cuff tear

Lin

Hsu

et al. 2021

PLoS ONE

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Critical shoulder angle (CSA) is the angle between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion and is potentially affected during a rotator cuff tear (RCT). Acromioplasty is generally performed to rectify the anatomy of the acromion during RCT repair surgery. However, limited information is available regarding the changes in the CSA after anterolateral acromioplasty. We hypothesized that CSA can be decreased after anterolateral acromioplasty. Data were retrospectively collected from 712 patients with RCTs and underwent arthroscopic rotator cuff repair between January 2012 and December 2018, of which 337 patients were included in the study. The presurgical and postsurgical CSA were then determined and compared using a paired samples t test. Because previous study mentioned CSA more than 38 degrees were at risk of rotator cuff re-tear, patients were segregated into two groups: CSA < 38° and CSA ≥ 38°; these groups were compared using an independent-samples t test. These 337 participants (160 male and 177 female) presented a CSA of 38.4° ± 6.0° before anterolateral acromioplasty, which significantly decreased to 35.8° ± 5.9° after surgery (P < .05). Before surgery, 172 patients were present in the CSA ≥ 38° group and 57 were preset in the CSA < 38° group after surgery. The CSA decreased significantly in the CSA ≥ 38° group rather than in the CSA < 38° group (P < .05). In conclusion, the CSA can be effectively decreased through anterolateral acromioplasty, and this reduction in the CSA is more significant among individuals with CSA ≥ 38° than among those with CSA < 38°, indicating that acromioplasty is recommended along with RCT repair especially among individuals with a wide presurgical CSA.

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The critical shoulder angle (CSA) in glenohumeral osteoarthritis: Does observer experience affect measurement reliability on plain radiographs?

Cited by 8 publications

References 19 publications

Optimization of the Grashey View Radiograph for Critical Shoulder Angle Measurement: A Reliability Assessment With Zero Echo Time MRI

Optimization of the Grashey View Radiograph for Critical Shoulder Angle Measurement: A Reliability Assessment With Zero Echo Time MRI

Accuracy of Critical Shoulder Angle and Acromial Index for Predicting Supraspinatus Tendinopathy

Acromioplasty reduces critical shoulder angle in patients with rotator cuff tear

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