Association Between Rotator Cuff Tears and Superior Migration of the Humeral Head: An MRI-Based Anatomic Study

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Abstract

Background:

Superior humeral migration has been established as a component of rotator cuff disease, as it disrupts normal glenohumeral kinematics. Decreased acromiohumeral interval (AHI) as measured on radiographs has been used to indicate rotator cuff tendinopathy. Currently, the data are mixed regarding the specific rotator cuff pathology that contributes the most to humeral head migration.

Purpose:

To determine the relationship between severity of rotator cuff tears (RCTs) and AHI via a large sample of magnetic resonance imaging (MRI) shoulder examinations.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A search was performed for 3-T shoulder MRI performed in adults for any indication between January 2010 and June 2019 at a single institution. Three orthopaedic surgeons and 1 musculoskeletal radiologist measured AHI on 2 separate occasions for patients who met the inclusion criteria. Rotator cuff pathologies were recorded from imaging reports made by fellowship-trained musculoskeletal radiologists.

Results:

A total of 257 patients (mean age, 52 years) met the inclusion criteria. Of these, 199 (77%) had at least 1 RCT, involving the supraspinatus in 174 (67.7%), infraspinatus in 119 (46.3%), subscapularis in 80 (31.1%), and teres minor in 3 (0.1%). Full-thickness tears of the supraspinatus, infraspinatus, or subscapularis tendon were associated with significantly decreased AHI (7.1, 5.3, and 6.8 mm, respectively) compared with other tear severities ( P < .001). Having a larger number of RCTs was also associated with decreased AHI (ρ = –0.157; P = .012). Isolated infraspinatus tears had the lowest AHI (7.7 mm), which was significantly lower than isolated supraspinatus tears (8.9 mm; P = .047).

Conclusion:

Although various types of RCTs have been associated with superior humeral head migration, this study demonstrated a significant correlation between a complete RCT and superior humeral migration. Tears of the infraspinatus tendon seemed to have the greatest effect on maintaining the native position of the humeral head. Further studies are needed to determine whether early repair of these tears can slow the progression of rotator cuff disease.

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Most cited references 13

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Roentgenographic findings in massive rotator cuff tears. A long-term observation.

Y. Kobayashi, K Hamada, David Fukuda … (1990)

It is difficult to determine the size and localization of rotator cuff tears preoperatively. But with the special arthrographic technique, a diagnosis with about 80% accuracy was possible in 65 surgically confirmed rotator cuff tears. With this technique, 22 massive cuff tears were found in conservatively treated patients. In these patients, the plain roentgenograms obtained at the initial examination were also analyzed. The roentgenographic findings included narrowing of the acromiohumeral interval and degenerative changes of the humeral head, the tuberosities, the acromion, the acromioclavicular joint, and the glenohumeral joint. Based on these data, five roentgenographic grades of massive cuff tears were identified. Of seven patients with massive tears, which had been treated conservatively and followed for more than eight years, the roentgenographic grades advanced in five. One shoulder progressed to cuff-tear arthropathy. Based on these observations, it is proposed that the following pathogenetic mechanisms are responsible for the progressive roentgenographic changes: (1) arm elevation in activities of daily living, (2) rupture of the long head of biceps tendon, (3) the abnormal fulcrum of the humeral head against the acromion and the coracoacromial ligament, and (4) the weakness of external rotation. A massive cuff tear will progress to cuff-tear arthropathy, with each step of progression accompanied by characteristic roentgenographic changes.

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Association between rotator cuff abnormalities and reduced acromiohumeral distance.

Marco Zanetti, Bernhard Jost, Christian Pfirrmann … (2006)

The purpose of this study was to evaluate the association between rotator cuff abnormalities and reduced acromiohumeral distance. Acromiohumeral distance was measured on conventional radiographs and on MR images. Three age- and sex-matched patient groups each including 21 patients were stratified according to acromiohumeral distance on conventional radiographs (group 1, 10 mm). Acromiohumeral distance was related to the presence, location, and size of a rotator cuff tear and the degree of fatty degeneration of the muscle assessed on MR arthrography. The relative influence on acromiohumeral distance of the various MR arthrographic findings was assessed. Spearman's rank correlation and stepwise regression were used for statistical analysis. In group 1 (acromiohumeral distance

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Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff.

Mari Uomizu, Ichiro Sekiya, Kazuhiko Maeda … (2008)

It is generally believed that the supraspinatus is the most commonly involved tendon in rotator cuff tears. Clinically, however, atrophy of the infraspinatus muscle is frequently observed in patients with even small to medium-size rotator cuff tears. This fact cannot be fully explained by our current understanding of the anatomical insertions of the supraspinatus and infraspinatus. The purpose of this study was to reinvestigate the humeral insertions of these tendons. The study included 113 shoulders from sixty-four cadavers. The humeral insertion areas of the supraspinatus and infraspinatus were investigated in ninety-seven specimens. In sixteen specimens, all muscular portions of the supraspinatus and infraspinatus were removed, leaving the tendinous portions intact, in order to define the specific characteristics of the tendinous portion of the muscles. Another twenty-six shoulders were used to obtain precise measurements of the footprints of the supraspinatus and infraspinatus. The supraspinatus had a long tendinous portion in the anterior half of the muscle, which always inserted into the anteriormost area of the highest impression on the greater tuberosity and which inserted into the superiormost area of the lesser tuberosity in 21% of the specimens. The footprint of the supraspinatus was triangular in shape, with an average maximum medial-to-lateral length of 6.9 mm and an average maximum anteroposterior width of 12.6 mm. The infraspinatus had a long tendinous portion in the superior half of the muscle, which curved anteriorly and extended to the anterolateral area of the highest impression of the greater tuberosity. The footprint of the infraspinatus was trapezoidal in shape, with an average maximum medial-to-lateral length of 10.2 mm and an average maximum anteroposterior width of 32.7 mm. The footprint of the supraspinatus on the greater tuberosity is much smaller than previously believed, and this area of the greater tuberosity is actually occupied by a substantial amount of the infraspinatus.

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Author and article information

Journal

Journal ID (nlm-ta): Orthop J Sports Med

Journal ID (iso-abbrev): Orthop J Sports Med

Journal ID (publisher-id): OJS

Journal ID (hwp): spojs

Title: Orthopaedic Journal of Sports Medicine

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Electronic): 2325-9671

Publication date (Electronic): 10 June 2021

Publication date Collection: June 2021

Volume: 9

Issue: 6

Electronic Location Identifier: 23259671211009846

Affiliations

[* ]Department of Orthopaedic Surgery, Ringgold 12220, universityUniversity of California, San Diego; , San Diego, California, USA.

[† ]Department of Musculoskeletal Radiology, Ringgold 12220, universityUniversity of California, San Diego; , San Diego, California, USA.

[‡ ]Division of Orthopaedic Surgery, Ringgold 14444, universityRady Children’s Hospital, San Diego; , California, USA.

[4-23259671211009846] Investigation performed at Rady Children’s Hospital, San Diego, California, USA

Author notes

[*] [§ ]Eric W. Edmonds, MD, Rady Children’s Hospital San Diego, 3020 Children’s Way, San Diego, CA 92123, USA (email: ewedmonds@ 123456rchsd.org ).

Article

Publisher ID: 10.1177_23259671211009846

DOI: 10.1177/23259671211009846

PMC ID: 8202287

SO-VID: 700b1955-e724-4e41-b055-411c85d5632d

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License ( https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 2 December 2020

Date accepted : 5 January 2021

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Keywords: mri,rotator cuff tear,rotator cuff arthropathy,hamada classification,shoulder,acromiohumeral interval,superior migration,rotator cuff repair,shoulder arthroplasty,superior capsular reconstruction

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Keywords: mri, rotator cuff tear, rotator cuff arthropathy, hamada classification, shoulder, acromiohumeral interval, superior migration, rotator cuff repair, shoulder arthroplasty, superior capsular reconstruction

Association Between Rotator Cuff Tears and Superior Migration of the Humeral Head: An MRI-Based Anatomic Study

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Abstract

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Study Design:

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Results:

Conclusion:

Related collections

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Most cited references 13

Roentgenographic findings in massive rotator cuff tears. A long-term observation.

Association between rotator cuff abnormalities and reduced acromiohumeral distance.

Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff.

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