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

Siow, Matthew Y.; Mitchell, Brendon C.; Hachadorian, Michael E.; Wang, Wilbur; Bastrom, Tracey P.; Kent, William T.; Huang, Brady K.; Edmonds, Eric W.

doi:10.1177/23259671211009846

Cited by 15 publications

(12 citation statements)

References 14 publications

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“…This inconsistency among the readers is most probably due to the difficulties to identify the landmarks for Deutsch and Moloney as stated above. The finding of a reduced ACHD in shoulders with rotator cuff tear was well expected and has been shown in many studies [23][24][25][26]. As a further refinement, our data strongly suggest that an ACHD ≤ 6 mm is a realistic threshold to infer a rotator cuff pathology since all of the 152 control shoulders had an ACHD of ≥ 7 mm.…”

Section: Discussionsupporting

confidence: 86%

The robustness of glenohumeral centering measurements in dependence of shoulder rotation and their predictive value in shoulders with rotator cuff tears

et al. 2022

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Objective De-centering of the shoulder joint on radiographs is used as indicator for severity of rotator cuff tears and as predictor for clinical outcome after surgery. The objective of the study was to assess the effect of malrotation on glenohumeral centering on radiographs and to identify the most reliable parameter for its quantification. Subjects and methods. In this retrospective study (2014–2018), 249 shoulders were included: 92 with imaging-confirmed supra- and infraspinatus tears (rupture; 65.2 ± 9.9 years) and 157 without tears (control; 41.1 ± 13.0 years). On radiographs in neutral position and external rotation, we assessed three radiographic parameters to quantify glenohumeral centering: acromiohumeral distance (ACHD), craniocaudal distance of the humeral head and glenoid center (Deutsch), and scapulohumeral arch congruity (Moloney). Non-parametric statistics was performed. Results In both positions, only the distance parameters ACHD (< 0.5 mm) and Deutsch (< 1 mm) were comparable in the two study groups rupture and control. Comparing the parameters between the study groups revealed only ACHD to be significantly different with a reduction of more than 2 mm in the rupture group. Among the parameters, ACHD ≤ 6 mm was the only cut-off discriminating rupture (12–21% of the shoulders with ACHD ≤ 6 mm) and control (none of the shoulders with ACHD ≤ 6 mm). Ninety percent of shoulders with ACHD ≤ 6 mm presented with a massive rotator cuff tear (defined as ≥ 67% of the greater tuberosity exposed). Conclusion Glenohumeral centering assessed by ACHD and Deutsch is not affected by rotation in shoulders with and without rotator cuff tear. An ACHD ≤ 6 mm has a positive predictive value of 90% for a massive rotator cuff tear.

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Section: Discussionsupporting

confidence: 86%

The robustness of glenohumeral centering measurements in dependence of shoulder rotation and their predictive value in shoulders with rotator cuff tears

et al. 2022

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“…Narrowing of the AHI, indicating superior migration of the humeral head, was thought to reflect the presence of rotator cuff tears, especially multiple-tendon rotator cuff tears involving the ISP. 17,20 In a previous study, patients with massive rotator cuff tears and a reduced range of motion in elevation and ER had a significantly narrower AHI than did patients with massive rotator cuff tears without a reduction in the range of motion. 2 The underlying mechanism is unknown; however, since the percentage of patients with superior migration of the humeral head increased as the stage of fatty infiltration of the SSP and ISP advanced, 17 superior migration of the humeral head may reflect severe fatty infiltration of the involved muscle and long duration from the onset of tendon rupture, which can explain the reduction of the range of anterior elevation and ER in this study.…”

Section: Discussionmentioning

confidence: 92%

Risk Factors for Loss of Active Shoulder Range of Motion in Massive Rotator Cuff Tears

Furuhata

Matsumura

Oki

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Patients with massive rotator cuff tears often exhibit loss of active range of shoulder motion, which can interfere with activities of daily living. The risk factors for loss of motion remain largely unknown. Purpose: To clarify the predictive factors that affect the range of motion in chronic massive rotator cuff tears using multivariate analyses. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively reviewed 204 consecutive patients who were evaluated at their institution with chronic massive rotator cuff tears. In this study, the dependent variable was determined to be active anterior elevation limited to ≤90° or external rotation (ER) with the arm at the side limited to ≤0°. Explanatory variables included age; sex; affected side; duration of symptoms; smoking history; existence of diabetes, hypertension, or rheumatoid arthritis; involved tendons; presence of a 3-tendon tear; rupture of the long head of biceps tendon; superior migration of the humeral head; and cuff tear arthropathy. Baseline variables that were observed to be significant in the univariate analyses were included in multivariate models, which used logistic regression to identify independent predictors of loss of motion. Results: Overall, 73 patients (35.8%) exhibited limited anterior elevation, and 27 (13.2%) exhibited limited ER. Multivariate analyses showed that inferior subscapularis tear (odds ratio [OR], 14.66; 95% CI, 2.95-72.93; P = .001), smoking (OR, 4.13; 95% CI, 1.94-8.79; P < .001), superior migration of humeral head (OR, 3.92; 95% CI, 1.80-8.53; P = .001), and 3-tendon tear (OR, 3.29; 95% CI, 1.32-8.20; P = .011) were significantly associated with the loss of anterior elevation. Teres minor tear (OR, 73.37; 95% CI, 9.54-564.28; P < .001) and superior migration of the humeral head (OR, 3.55; 95% CI, 1.04-12.19; P = .044) were significantly associated with loss of ER. Conclusion: In the current study, a history of smoking, type of torn tendons, and superior migration of the humeral head were associated with loss of active shoulder motion. In particular, the status of inferior subscapularis or teres minor contributed to the onset of pseudoparalysis in massive rotator cuff tears.

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“…In a recent study showed that RC tear causes humeral migration by affecting the dynamic stabilizers of the shoulder [ 21 ]. In addition, about imaging methods to evaluate the displacement of the humeral head in RC tears, they evaluated the benefits of parameters such as upward migration index, inferior glenohumeral distance, acromial index and critical shoulder angle other than AHD.…”

Section: Discussionmentioning

confidence: 99%

“…The higher likelihood of LHBT pathology, with the increasing size of RC tears, may be a consequence of its functioning as a suppressor of the humeral head [ 1 ]. A study showed that any RC tear compromises the dynamic stabilizers of the shoulder and significantly leads to superior humeral migration [ 21 ]. Subacromial impingement may also contribute to LHBT pathology in the presence of an RC tear [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of biceps tenotomy on humeral migration and clinical outcomes in arthroscopic rotator cuff repair

Çakar

Güney

et al. 2022

J EXP ORTOP

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Purpose To evaluate the effect of biceps tenotomy on humeral migration and clinical outcomes in patients who underwent arthroscopic rotator cuff (RC) repair. Methods This is a retrospective study of 60 patients who underwent arthroscopic RC repair. Patients were divided into two groups, whether they underwent concomitant biceps tenotomy or not. The group underwent concomitant biceps tenotomy, tenotomy ( +), or not, tenotomy (-). Clinical and functional outcomes were performed using the American Shoulder and Elbow Surgeons (ASES), the University of California-Los Angeles (UCLA) scoring system. Radiological evaluation was performed in X-rays and magnetic resonance imaging (MRI), measuring the acromiohumeral distance (AHD), humeral migration (HM) and upper migration index (UMI). Results There was no significant difference between the groups in terms of patient characteristics. The follow-up period was 30.9 ± 8.7 months in the tenotomy ( +) group and 34.9 ± 8.2 months in the tenotomy (-) group with no significant difference. Postoperative ASES score improved significantly in the tenotomy ( +) group compared to the tenotomy (-) group (91.2 ± 4.7, 80.8 ± 18.7, respectively, p = 0.005). There was a significant difference in postoperative AHD, HM and UMI values (MRI; p = 0.003, p = 0.017, p = 0.025; X-ray; p = 0.049, p = 0.002, p = 0.010, respectively). The post–pre difference increase of AHD [MRI for tenotomy( +): 0.14 ± 0.86 and tenotomy(-): 0.91 ± 0.85, p = 0.001; X-ray for tenotomy( +): 0.61 ± 0.43 and tenotomy(-): 1.12 ± 0.7, p = 0.001] and UMI [MRI for tenotomy( +): 0.005 ± 0.05 and tenotomy(-): 0.04 ± 0.06, p = 0.006; X-ray for tenotomy( +): 0.01 ± .064 and tenotomy(-): 0.12 ± 0.37, p = 0.110] values were higher in the tenotomy (-) group compared to the tenotomy ( +) group while HM values decreased more in the tenotomy (-) group. [MRI for tenotomy ( +): -0.19 ± 1.07 and tenotomy (-): -0.79 ± 1.52, p = 0.079; X-ray for tenotomy ( +): -0.27 ± 0.54 and tenotomy (-): -1.006 ± 1.83, p = 0.040]. Conclusion After short-term follow-up, the humeral head was positioned higher in patients who underwent LHBT tenotomy compared to patients without tenotomy. However, it seems to affect clinical outcomes during this period positively. Level of Evidence Level 3

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

Cited by 15 publications

References 14 publications

The robustness of glenohumeral centering measurements in dependence of shoulder rotation and their predictive value in shoulders with rotator cuff tears

The robustness of glenohumeral centering measurements in dependence of shoulder rotation and their predictive value in shoulders with rotator cuff tears

Risk Factors for Loss of Active Shoulder Range of Motion in Massive Rotator Cuff Tears

The effect of biceps tenotomy on humeral migration and clinical outcomes in arthroscopic rotator cuff repair

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