Less than 9.5-mm coracohumeral distance on axial magnetic resonance imaging scans predicts for subscapularis tear

Abstract

Background Diagnosis of subscapularis (SSC) tendon lesions on magnetic resonance imaging (MRI) can be challenging. A small coracohumeral distance (CHD) has been associated with SSC tears. This study was designed to define a specific threshold value for CHD to predict SSC tears on axial MRI scans. Methods This retrospective study included 172 shoulders of 168 patients who underwent arthroscopic surgery for rotator cuff tear or glenohumeral instability. Diagnostic arthroscopy confirmed an SSC tear in 62 cases (36.0%, test group a), rotator cuff tear tears other than SSC in 71 cases (41.3%, control group b) and glenohumeral instability without any rotator cuff tear in 39 cases (22.7%, zero-sample group c). All patients had a preoperative MRI of the shoulder (1.5T or 3T). Minimum CHD was measured on axial fat-suppressed proton density-, T2-, or T1-weigthed sequences. Receiver operating characteristics analysis was used to determine the threshold value for CHD, and sensitivity and specificity were calculated. Results CHD measurement had a good interobserver reliability (Intraclass correlation coefficient 0.799). Mean CHD was highly significantly ( P < .001) less for test group a (mean 7.3 mm, standard deviation ± 2.2) compared with control group b (mean 11.1 mm, standard deviation ± 2.3) or zero-sample group c (mean 13.6 mm, standard deviation ± 2.9). A threshold value of CHD <9.5 mm had a sensitivity of 83.6% and a specificity of 83.9% to predict SSC tears. Conclusion A CHD <9.5 mm on MRI is predictive of SSC lesions and a valuable tool to diagnose SSC tears.

Alteration in coracohumeral ligament and distance in people with symptoms of subcoracoid impingement

“…Compared to the unaffected side, the thickening of the CHL on the affected side was similar in both groups (difference: SIS = 0.6 mm and SSCL = 0.7 mm). Previous studies also reported thicker CHLs in other shoulder pathologies, such as frozen shoulder and anterior instability [ 26 , 27 ]. Thus, the CHL thickness in SIS patients could be related to the occurrence of subcoracoid impingement.…”

“…Similar to this finding, our results showed that the CHD was narrowest in IRFA and widest in ER positions. Reichel et al [ 26 ] suggest that a CHD width of less than 9.5 mm can predict SSC lesion. Regarding our results, the narrow CHD in CHDIR (9.4 mm) and CHDIRFA (8.7 mm) on the affected side might cause possible impingement and subsequently SSC lesion.…”

Alteration in coracohumeral ligament and distance in people with symptoms of subcoracoid impingement

“…Compared to the unaffected side, the thickening of the CHL on the affected side was similar in both groups (difference: SIS = 0.6 mm and SSCL = 0.7 mm). Previous studies also reported thicker CHLs in other shoulder pathologies, such as frozen shoulder and anterior instability [25,26]. Thus, the CHL thickness in SIS patients could be related to the occurrence of subcoracoid impingement.…”

“…Similar to this nding, our results showed that the CHD was narrowest in IRFA and widest in ER positions. Reichel et al [25] suggest that a CHD width of less than 9.5 mm can predict SSC lesion. Regarding our results, the narrow CHD in CHDIR (9.4 mm) and CHDIRFA (8.7 mm) on the affected side might cause possible impingement and subsequently SSC lesion.…”

The effect of arthroscopic coracoplasty on subscapularis strength in cases of subcoracoid impingement in the absence of subscapularis tear

“…[25] Most recently, Hodax et al reported a CHD distance of 13.7 mm as the lower limit of normal, which was measured in 714 healthy asymptomatic patients. [26] Both postoperative and preoperative measurements were below the normal range reported by Reichel et al [25] Unlike the clinical studies mentioned above, this study is the first to report a negative relationship between gain in belly press strength and postoperative CHD. This may partially explain the absence of the beneficial effect of concomitant coracoplasty reported in the literature in cases where subscapularis tendon repair is required.…”