קרעים בגידי השרוול המסובב

 

Rotator cuff injury

Matan sadot

Diagnostic imaging 2022

The college of St. Scholastica

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Background

 

    Rotator cuff injury is one of the most common causes of pain and shoulder dysfunction, affecting people’s daily living activities, such as the ability to reach into a kitchen shelf, wash their back, and fix their hair. (Wofford et al., 2005)

    The incidence of rotator cuff injury is ranged from 7 to 30% in the general population and increases with age. (Karas et al.,

2012)

    The rotator cuff is a group of four muscles and tendons, including supraspinatus, infraspinatus, teres minor, and subscapularis which stabilize and play an important role in the dynamic stability of the shoulder and the glenohumeral joint.

     * long head of biceps tendon as an important player

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Acute vs overuse

Acute injury- caused by trauma or severe irritation of the rotator cuff muscle results in soft tissue strains, tears, and tendinitis.

Chronic - wear and tear over time, the tendons that connect muscles to bones can overstretch (strain) or tear, partially or completely. (Itoi, 2013)

 

Degenerative injuries :

  • 1.athletes, usually hand use such as water polo,

tennis, handball, etc.

  • 2. jobs that require repetitive lifting, like physical
 

Acute injuries:

  • can be caused by lifting objects that are too    • heavy, falling, or having the shoulder forced into an awkward position.
 

jobs – carpenters, technicians

  • 3.people above 40 years of age
  • 4. dominant hand
  • (Sayampanathan & Andrew, 2017)
 

2. Young people are more likely to experience this     •

type of rotator cuff injury

 
 
 

Clinical examination:

medical history a physical exam imaging scans

    Medical history – attention- fracture/dislocation shoulder region and diabetes or metabolic disorders (Rechardt et al., 2010)

    Clinical Presentation –aggravating factors such as overhead activity/ lifting objects. In addition night pain or at rest, lying, and pressure on the suspected shoulder

    Physical exams and special tests: tests can be the most cost-effective diagnostic procedure but the evidence regarding the accuracy of the tests vary and many of the studies present in the literature, have not reported likelihood ratios that can help the clinician understand the usefulness of the test. (Villafañe et al., 2015)

    The Yocum, Jobe, Patte, Neer, and Hawkins-Kenedy tests can provide clinically useful information regarding the presence of a lesion of the supraspinatus tendon when combined with other clinical findings. The Yocum, Jobe, Hawkins—Kennedy tests can be useful in combination with the pre-test probability of the condition to rule out individuals without a partial tear of the supraspinatus tendon(Villafañe et al., 2015)

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    Range of motion: painful arc in the physical exam can correlate to scapular Y radiographic findings.

    Clinical integration physical exam and continue diagnostic imaging.

(Villafañe et al., 2015)

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Imaging modalities

 

Radiology

includes two anteroposterior

projections

 

MRI shoulder without IV contrast and ultrasound in Suspect rotator cuff disorders

 

    Appropriateness Criteria– radiology as an initial image for the atraumatic shoulder.

    MRI shoulder without IV contrast and ultrasound in Suspect rotator cuff disorders. Initial radiographs are normal or inconclusive

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Variant 1

 

  • Anteroposterior external rotation radiograph of the

left shoulder

  • Anteroposterior internal rotation radiograph of the left shoulder

* On the anteroposterior ER view of the shoulder, the distance x from the glenoid fossa to the humeral head averages 5 mm – others result in further Atraumatic investigation.

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additional projection - scapular Y radiographic

 

 

 

    the subacromial space is well visualized

    The arrow might be calcification of a partial rotator cuff rupture or fibrosis, as well as

calcification.

*when impingement syndrome is suspected

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MRI – variant 2

    Define the anatomy - Commonly used anatomy-defining sequences are T1-weighted, gradient-echo (GRE), and proton density (PD)

    Detect abnormal fluid - Commonly used fluid-sensitive sequences are T2-weighted, fat saturation, and inversion recovery (IR).

    Example - oblique Coronal Plane:

 

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Variant 2 - ultrasound

    Diagnostic ultrasound, is a dynamic real-time imaging modality.

    Advantages - low cost, the safety of use, modification of the examination.

    Disadvantages - operator dependency and inability to scan intra-articular structures

    Sensitivity and specificity are 66% and 93% when conducted by a skilled examiner

 

https://123sonography.com/

 
 
 

Imaging findings

 

    Soft tissue pathologies –tendon, muscles, and ligaments tears

    Degeneration – joints and soft tissue

    Supraspinatus tendon – red arrow direct hypoechoic area and may indicate a tendon tear

 

 

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findings MRI

    Alignment – There is no bone disruption.

    Bone signal – there are no bone bruises.

    Cartilage - evaluate the glenohumeral joint surfaces for articular cartilage abnormalities.

    eDema – observation for an inflammatory condition characterized by mechanical impingement of tissues under the coracoacromial arch, which may vary from edema to full-thickness tendon rupture.

    Soft and synovial tissue - Investigate the rotator cuff muscles and tendons for continuity. Is there any

disruption as a consequence of tears?

 
 
 

Clinical impact

    Shoulder region diagnostic imaging – reliable and accurate modality. (Taneja et al., 2014)

 Finding must be interpreted with special tests – for example, examining supraspinatus tears compared to the contralateral healthy shoulder. (real-time diagnostic ultrasound)

Unique results \ clinical integration finding = signs and symptoms

    Full tendon tear – adjust our recommendations and rehab program

    Clinical practice guidelines (CPG) provide evidence-based recommendations for current orthopedic diagnostic, treatment, and postoperative procedures

    Special tests sensitivity and specificity

    The use of accessible imaging modalities - ultrasound

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References:

         Itoi, E. (2013). Rotator cuff tear: Physical examination and conservative treatment. Journal of Orthopaedic Science, 18(2), 197–204. https://doi.org/10.1007/s00776-012-0345-2

         Karas, V., Cole, B. J., & Wang, V. M. (2012). Role of Biomechanics in Rotator Cuff Pathology: North American Perspective. In Medicine and Sport Science (Vol. 57, pp. 18–26). https://doi.org/10.1159/000328871

         Nazarian, L. N., Jacobson, J. A., Benson, C. B., Bancroft, L. W., Bedi, A., McShane, J. M., Miller, T. T., Parker, L., Smith, J., Steinbach, L. S., Teefey, S. A., Thiele, R. G., Tuite, M. J., Wise, J. N., & Yamaguchi, K. (2013). Imaging algorithms for evaluating suspected rotator cuff disease: Society of radiologists in ultrasound consensus conference statement. Radiology, 267(2), 589–595. https://doi.org/10.1148/radiol.13121947

         Rechardt, M., Shiri, R., Karppinen, J., Jula, A., Heliövaara, M., & Viikari-Juntura, E. (2010). Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: A population-based study. http://www.biomedcentral.com/1471-2474/11/165

         Sayampanathan, A. A., & Andrew, T. H. C. (2017). Systematic review on risk factors of rotator cuff tears. Journal of Orthopaedic Surgery (Hong Kong),

25(1). https://doi.org/10.1177/2309499016684318

         Taneja, A. K., Kattapuram, S. v., Chang, C. Y., Simeone, F. J., Bredella, M. A., & Torriani, M. (2014). MRI findings of rotator cuff myotendinous junction injury. American Journal of Roentgenology, 203(2), 406–411. https://doi.org/10.2214/AJR.13.11474

         Villafañe, J. H., Valdes, K., Anselmi, F., Pirali, C., & Negrini, S. (2015). The diagnostic accuracy of five tests for diagnosing partial-thickness tears of the supraspinatus tendon: A cohort study. Journal of Hand Therapy, 28(3), 247–252. https://doi.org/10.1016/j.jht.2015.01.011

         Wofford, J. L., Mansfield, R. J., & Watkins, R. S. (2005). Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: Secondary data analysis of the National Ambulatory Medical Care Survey. BMC Musculoskeletal Disorders, 6. https://doi.org/10.1186/1471- 2474-6-4

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