Background: Fatty atrophy is a diagnosis characterized by the combination of fatty infiltration and muscle atrophy of the rotator cuff. Studies have shown a strong positive correlation between the level of fatty infiltration and the risk of experiencing a chronic rotator cuff tear. Therefore, the purpose of the present study was to review the current literature on radiographic imaging of fatty infiltration and fatty atrophy to better aid surgeons in predicting functional outcome and to help guide patient decisions.Methods: We conducted a literature search in PubMed. The exact search queries included "rotator cuff" in the MeSH Terms field; "fatty atrophy," fatty infiltration," and "fatty muscle degeneration" in the Title/Abstract field; and various combinations of these searches. We initially found 184 articles using these keywords, including both human and animal studies. The 25 animal studies were excluded, leaving 159 articles. The abstracts of all remaining articles were reviewed and selected on the basis of our inclusion criteria of focusing on patients with rotator cuff tears (preoperatively and postoperatively), fatty infiltration, fatty atrophy, and imaging modalities. We excluded an additional 127 articles, leaving 32 articles that were selected for the final review and inclusion in this study.Results: Among 45 shoulder specialists across different studies, interrater agreement for Goutallier staging with use of magnetic resonance imaging (MRI) ranged from 0.24 to 0.82 and intrarater agreement for supraspinatus fatty changes ranged from 0.34 to 0.89. Our review also showed strong positive correlations when assessing the severity of fatty atrophy of the rotator cuff between MRI and ultrasound or ultrasound modalities such as sonoelastography.Conclusions: Increasing fatty infiltration of the rotator cuff is associated with greater repair failure rates and hence poorer overall clinical outcomes. MRI remains the gold standard for the imaging of rotator cuff tears and postoperative healing. Ultrasound can decrease health-care expenditures associated with the assessment of repair integrity postoperatively, although ultrasound is not as precise and has some limitations compared with MRI.Disclosure: There was no external funding source for the present study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJSREV/A443).

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Upper extremity arterial disease is relatively uncommon compared with lower extremity disease, but presents a unique diagnostic challenge for physicians and technologists. It affects approximately 5–10% of the population. The most common causes of upper extremity arterial disease are atherosclerosis and embolic disease. Some common symptoms of upper arterial disease include dysesthesia, paresthesia, pallor, cold intolerance, ulceration, pain, or weakness in one or both extremities. The vascular system plays a vital role in the delivering of nutrients and clearing metabolic waste products from the peripheral tissues and also helps maintain an individual's systemic core temperature. In a majority of patients, the deep and superficial palmar arches provide the dominant blood supply to the hand. The arches are a continuation of the radial and ulnar arteries. These arches are typically connected in approximately 80% of patients. In order to accurately diagnose upper extremity arterial disease, a noninvasive upper extremity physiologic examination is of importance to determine treatment options for patients. The physiologic examination includes upper extremity segmental pressures known as wrist-brachial index, Doppler waveforms; digital evaluations include photoplethysmography and pressures of the digits known as the digital-brachial index. Physiologic tests are indirect examinations. The upper extremity arterial physiologic examination is always completed bilaterally in order to determine if the disease is present in one or both extremities and also assists in the diagnosis of disease severity. The vascular physiologic examination should focus on the symptoms presented by the patient during the history. However, a complete vascular examination is appropriate given the diffuse nature of the atherosclerotic disease process.