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Tears at the rotator cuff footprint: Prevalence and imaging characteristics in 305 MR arthrograms of the shoulder

  • Musculoskeletal
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Abstract

Objectives

To evaluate the prevalence, imaging characteristics and anatomical distribution of tears at the rotator cuff (RC) footprint with MR arthrography (MR-A) of the shoulder.

Methods

MR arthrograms obtained in 305 patients were retrospectively reviewed. Partial articular-sided supraspinatus tendon avulsions (PASTA), concealed interstitial delaminations (CID), reverse PASTA lesions and full-thickness tears (FT) at the humeral tendon insertion were depicted. Anatomical locations were determined and depths of tears were classified.

Results

112/305 patients showed RC tears, including 63 patients with 68 footprint tears. 34 PASTA lesions were detected with 20/34 involving the anterior supraspinatus (SSP) tendon and 17/34 PASTA lesions were grade I lesions. Most CID lesions (14/23) occurred at the posterior SSP and 20/23 were classified as grade I or II. 9 FT and 2 reverse PASTA lesions were found. Statistical analysis revealed no difference in anatomical location (p = 0.903) and no correlation with overhead sports activity (p = 0.300) or history of trauma (p = 0.928). There were significantly more PASTA lesions in patients <40 years of age (p = 0.029).

Conclusions

Most RC tears detected with MR-A involve the SSP footprint and are articular-sided with predominance in younger patients, but concealed lesions are not as uncommon as previously thought.

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References

  1. Mitchell C, Adebajo A, Hay E, Carr A (2005) Shoulder pain: diagnosis and management in primary care. BMJ 331:1124–1128

    Article  PubMed  Google Scholar 

  2. Macfarlane GJ, Hunt IM, Silman AJ (1998) Predictors of chronic shoulder pain: a population based prospective study. J Rheumatol 25:1612–1615

    PubMed  CAS  Google Scholar 

  3. Fukuda H (2003) The management of partial-thickness tears of the rotator cuff. J Bone Joint Surg Br 85:3–11

    Article  PubMed  CAS  Google Scholar 

  4. Bencardino JT, Garcia AI, Palmer WE (2003) Magnetic resonance imaging of the shoulder: rotator cuff. Top Magn Reson Imaging 14:51–67

    Article  PubMed  Google Scholar 

  5. Opsha O, Malik A, Baltazar R, Primakov D, Beltran S, Miller TT, Beltran J (2008) MRI of the rotator cuff and internal derangement. Eur J Radiol 68:36–56

    Article  PubMed  Google Scholar 

  6. DePalma AF (1983) Surgery of the shoulder, 3rd edn. Lippincott, Philadelphia

    Google Scholar 

  7. Rockwood CA, Matsen FA (2009) The shoulder, 4th edn. Saunders/Elsevier, Philadelphia

    Google Scholar 

  8. Lohr JF, Uhthoff HK (1990) The microvascular pattern of the supraspinatus tendon. Clin Orthop Relat Res 254:35–38

    PubMed  Google Scholar 

  9. Stetson WB, Phillips T, Deutsch A (2005) The use of magnetic resonance arthrography to detect partial-thickness rotator cuff tears. J Bone Joint Surg Am 87:81–88

    Article  PubMed  Google Scholar 

  10. Codman EA (1934) The shoulder. Thomas Todd, Boston

    Google Scholar 

  11. DeFranco MJ, Cole BJ (2009) Current perspectives on rotator cuff anatomy. Arthroscopy 25:305–320

    Article  PubMed  Google Scholar 

  12. Snyder SJ, Pachelli AF, Del Pizzo W, Friedman MJ, Ferkel RD, Pattee G (1991) Partial thickness rotator cuff tears: results of arthroscopic treatment. Arthroscopy 7:1–7

    Article  PubMed  CAS  Google Scholar 

  13. Burns JP, Snyder SJ (2008) Arthroscopic rotator cuff repair in patients younger than fifty years of age. J Shoulder Elbow Surg 17:90–96

    PubMed  Google Scholar 

  14. de Jesus JO, Parker L, Frangos AJ, Nazarian LN (2009) Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol 192:1701–1707

    Article  PubMed  Google Scholar 

  15. Tuite MJ, Turnbull JR, Orwin JF (1998) Anterior versus posterior, and rim-rent rotator cuff tears: prevalence and MR sensitivity. Skeletal Radiol 27:237–243

    Article  PubMed  CAS  Google Scholar 

  16. Vinson EN, Helms CA, Higgins LD (2007) Rim-rent tear of the rotator cuff: a common and easily overlooked partial tear. AJR Am J Roentgenol 189:943–946

    Article  PubMed  Google Scholar 

  17. Kassarjian A, Bencardino JT, Palmer WE (2006) MR imaging of the rotator cuff. Radiol Clin North Am 44:503–523

    Article  PubMed  Google Scholar 

  18. Ellman H (1990) Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res 254:64–74

    PubMed  Google Scholar 

  19. Habermeyer P, Krieter C, Tang K, Lichtenberg S, Magosch P (2008) A new arthroscopic classification of articular-sided supraspinatus footprint lesions: a prospective comparison with Snyder’s and Ellman’s classification. J Shoulder Elbow Surg 17:909–913

    Article  PubMed  Google Scholar 

  20. Mochizuki T, Sugaya H, Uomizu M, Maeda K, Matsuki K, Sekiya I, Muneta T, Akita K (2008) Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. J Bone Joint Surg Am 90:962–969

    Article  PubMed  Google Scholar 

  21. Kirchhoff C, Braunstein V, Milz S, Sprecher CM, Fischer F, Tami A, Ahrens P, Imhoff AB, Hinterwimmer S (2010) Assessment of bone quality within the tuberosities of the osteoporotic humeral head: relevance for anchor positioning in rotator cuff repair. Am J Sports Med 38:564–569

    Article  PubMed  Google Scholar 

  22. Rees JL (2008) The pathogenesis and surgical treatment of tears of the rotator cuff. J Bone Joint Surg Br 90:827–832

    Article  PubMed  CAS  Google Scholar 

  23. Neer CS (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am 54:41–50

    PubMed  Google Scholar 

  24. Nakagawa S, Yoneda M, Mizuno N, Hayashida K, Mae T, Take Y (2006) Throwing shoulder injury involving the anterior rotator cuff: concealed tears not as uncommon as previously thought. Arthroscopy 22:1298–1303

    Article  PubMed  Google Scholar 

  25. Fukuda H, Hamada K, Nakajima T, Tomonaga A (1994) Pathology and pathogenesis of the intratendinous tearing of the rotator cuff viewed from en bloc histologic sections. Clin Orthop Relat Res 304:60–67

    PubMed  Google Scholar 

  26. Budoff JE, Nirschl RP, Guidi EJ (1998) Debridement of partial-thickness tears of the rotator cuff without acromioplasty. Long-term follow-up and review of the literature. J Bone Joint Surg Am 80:733–748

    PubMed  CAS  Google Scholar 

  27. Waldt S, Bruegel M, Mueller D, Holzapfel K, Imhoff AB, Rummeny EJ, Woertler K (2007) Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation. Eur Radiol 17:491–498

    Article  PubMed  CAS  Google Scholar 

  28. Iannotti JP, Zlatkin MB, Esterhai JL, Kressel HY, Dalinka MK, Spindler KP (1991) Magnetic resonance imaging of the shoulder. Sensitivity, specificity, and predictive value. J Bone Joint Surg Am 73:17–29

    PubMed  CAS  Google Scholar 

  29. Zlatkin MB, Iannotti JP, Roberts MC, Esterhai JL, Dalinka MK, Kressel HY, Schwartz JS, Lenkinski RE (1989) Rotator cuff tears: diagnostic performance of MR imaging. Radiology 172:223–229

    PubMed  CAS  Google Scholar 

  30. Balich SM, Sheley RC, Brown TR, Sauser DD, Quinn SF (1997) MR imaging of the rotator cuff tendon: interobserver agreement and analysis of interpretive errors. Radiology 204:191–194

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany

    Christoph Schaeffeler, Dirk Mueller, Ernst J. Rummeny & Klaus Woertler

  2. Department of Orthopedics and Traumatology, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany

    Chlodwig Kirchhoff

  3. Institute of Medical Statistics and Epidemiology, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany

    Petra Wolf

Authors
  1. Christoph Schaeffeler
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  2. Dirk Mueller
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  3. Chlodwig Kirchhoff
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  4. Petra Wolf
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  5. Ernst J. Rummeny
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  6. Klaus Woertler
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Correspondence to Christoph Schaeffeler.

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Schaeffeler, C., Mueller, D., Kirchhoff, C. et al. Tears at the rotator cuff footprint: Prevalence and imaging characteristics in 305 MR arthrograms of the shoulder. Eur Radiol 21, 1477–1484 (2011). https://doi.org/10.1007/s00330-011-2066-x

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  • DOI: https://doi.org/10.1007/s00330-011-2066-x

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