Transcript Rotator cuff tears

2/16
Morning meeting
Rotator cuff tears:
Clinical, radiographic and US findings
~Radiographics 2005
reporter
郭哲佑
Index
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Introduction
Clinical evaluation
Radiographic evaluation
US evaluation
Introduction
Which is the best image modality to
evaluate rotator cuff tear?
a) US
b) MRI
Introduction
US = MRI
in terms of
• Sensitivity (≒ 90%)
• Specificity (≒ 90%)
Introduction
• Clinical examination is Helpful
Anatomy of shoulder
• Clavicle, Scapula,
Humerus
• Glenohumeral joint
• Great ROM
Rotator cuff
• Subscapularis
• Suprascapularis
• Infrascapularis
• Teres minor
Function of rotator cuff
Stabilize the joint
• Subscapularis: internal rotation
• Suprascapularis: abduction
• Infrascapularis: external rotation
• Teres minor: external rotation
Impingement syndrome
Rotator cuff tear
End result of
a) Chronic impingement syndrome
b) Tendon degeneration
c) Traumatic injury
*repetitive microtrauma Age
# increased with age, > 55 yr, 50%
Clinical evaluation
Clinical presentation
• Shoulder pain
pain aggravated by reaching, pushing, pulling,
lifting, or positioning the arm above shoulder
level
• Weakness
related to the size of the tear
• Loss of shoulder function
Most useful clinical tests
Supraspinatus weakness
Weakness of external rotation
Impingement
All three positive 3/3 or 2/3 + pt. > 60y
→ 98% rotator cuff tear
~Murrell GA and Walton JR: Diagnosis of rotator cuff tear.
Lancet 2001;357:1452
Most useful clinical tests
Supraspinatus weakness
Weakness of external rotation
infraspinatus
Impingement
All three positive 3/3 or 2/3 + pt. > 60y
→ 98% rotator cuff tear
~Murrell GA and Walton JR: Diagnosis of rotator cuff tear.
Lancet 2001;357:1452
US
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High frequency: 10~12 MHz
Linear transducer
US beam should perpendicular to the
tendon
US
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Biceps
Subscapularis
Supraspinatus
Infraspinatus, teres minor, post.
Glenohumeral joint
US appearance of disease
Rotator cuff tear
• Full-thickness: hypoechoic defect (fluid,
accentuating the underlying cartiliage)
• Partial-thickness
Rotator cuff tear
Direct sign
• Non-visualization of supraspinatus tendon
• Hypoechoic discontinuity of the tendon
Indirect sign
• Double cortex sign
• Sagging peribursal fat sign
• Compressibility
• Muscle atrophy
Supraspinatus tendinosis
Calcific tendinitis
Calcium hydroxyapatite deposition
Etiology: unknown
Risk factors
• Gender F>M
• Race (Chinese)
• Occupation
• Gene (HLA-A1)
Acute calcific tendinitis: extreme pain
Chronic calcific tendinitis: impingement symptoms
Calcific tendinitis
Calcific tendinitis
Subacromial subdeltoid brusitis
DDx
Adhesive capsulitis(frozen shoulder) vs.
Rotator cuff tear
Adhesive capsulitis:
restruction of passive movement