MR imaging of the shoulder after surgery.

Magee, Thomas; Gaenslen, Eric S.; Seitz, Rüdiger J.; Hinson, G A; Wetzel, Louis H.

doi:10.2214/ajr.168.4.9124141

Cited by 94 publications

(97 citation statements)

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“…At the time of follow-up, all patients underwent MRI without arthrography on a 1.5-Tesla scanner (Siemens, Erlangen, Germany). Continuity or rupture of the tendon was assessed on coronal oblique T2-weighted and proton density-weighted images as well as short tau inversion recovery sequences according to established MRI criteria [21][22][23] .…”

Section: Imagingmentioning

confidence: 99%

Evolution of Nonoperatively Treated Symptomatic Isolated Full-Thickness Supraspinatus Tears

Fucentese

Roll

Pfirrmann

et al. 2012

Journal of Bone and Joint Surgery

105

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BACKGROUND: The natural history of small, symptomatic rotator cuff tears is currently unclear. The purpose of the present study was to assess the clinical and structural outcomes for a consecutive series of patients with symptomatic, isolated full-thickness supraspinatus tears who had been offered rotator cuff repair but declined operative treatment. METHODS: In the study period, twenty-four patients with isolated full-thickness supraspinatus tears that had been diagnosed by means of magnetic resonance arthrography were offered rotator cuff repair and elected nonoperative treatment. The twenty men and four women had an average age of fifty-two years at the time of diagnosis. At a median of fortytwo months after the diagnosis, all patients were reexamined clinically according to the Constant and Murley scoring system and all shoulders underwent standard magnetic resonance imaging. RESULTS: At the time of follow-up, the mean subjective shoulder score was 74% of that for a normal shoulder and the mean Constant score was 75 points (relative Constant score, 86%). The mean rotator cuff tear size did not change significantly over time (95% confidence interval, 0.51 to 1.12). In two shoulders, the tear was no longer detectable on magnetic resonance imaging, in nine shoulders the tear was smaller than it had been at the time of the initial diagnosis, in nine patients the tear had not changed, and in six patients the tear had increased in size. There was a slight but significant progression of fatty muscle infiltration of the supraspinatus, but no patient had fatty infiltration beyond stage 2 at the time of the latest follow-up (95% confidence interval, 0% to 14%). CONCLUSIONS: In a consecutive series of patients who had been offered repair of an isolated, symptomatic supraspinatus tear, the refusal of operative treatment resulted in surprisingly high clinical patient satisfaction and no increase of the average size of the rotator cuff tear 3.5 years after the recommendation of operative repair. This study confirms that the size of small rotator cuff tears does not invariably increase over a limited period of time. Distinguishing tears that will increase in size from those that will not needs further study. Background: The natural history of small, symptomatic rotator cuff tears is currently unclear. The purpose of the present

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Section: Imagingmentioning

confidence: 99%

Evolution of Nonoperatively Treated Symptomatic Isolated Full-Thickness Supraspinatus Tears

Fucentese

Roll

Pfirrmann

et al. 2012

Journal of Bone and Joint Surgery

105

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“…6a). Signal loss has been attributed to postoperative marrow fibrosis and sclerosis of the acromion and should not be misinterpreted as a sign of osteomyelitis [1,2,[7][8][9]. If the Mumford procedure was performed, the acromioclavicular distance is increased to 1-2 cm, seen as overall widening of the acromioclavicular joint on transverse images [1,2,9].…”

Section: Postoperative Imaging Findingsmentioning

confidence: 99%

“…8) or by another, so far undiagnosed pathology which simulates subacromial impingement, such as acromioclavicular osteoarthritis, calcific tendonitis, SLAP and pulley lesions, suprascapular nerve entrapment, and unrecognized instability [2,7,8,10,38,40].…”

Section: Postoperative Imaging Findingsmentioning

confidence: 99%

“…Various findings that indicate pathology in non-operated patients are less significant or even within the range of normal after specific surgical procedures or might be negligible in the absence of symptoms and functional deficits. Furthermore, the efficacy of MR imaging, MR arthrography, CT arthrography, and ultrasound for the detection of recurrent lesions and specific complications in patients, who have undergone surgery for shoulder instability, impingement, or rotator cuff tears, has yet to be confirmed [1][2][3][4][5][6][7][8][9][10]. At present, the choice of the most suited imaging technique and the interpretation of imaging findings in a specific postoperative setting are therefore in many aspects not only based on reproducible results of scientific studies but also on personal experience [7,8,10].…”

Section: Introductionmentioning

confidence: 99%

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Multimodality imaging of the postoperative shoulder

Woertler

2007

Eur Radiol

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Multimodality imaging of the postoperative shoulder includes radiography, magnetic resonance (MR) imaging, MR arthrography, computed tomography (CT), CT arthrography, and ultrasound. Target-oriented evaluation of the postoperative shoulder necessitates familiarity with surgical techniques, their typical complications and sources of failure, knowledge of normal and abnormal postoperative findings, awareness of the advantages and weaknesses with the different radiologic techniques, and clinical information on current symptoms and function. This article reviews the most commonly used surgical procedures for treatment of anterior glenohumeral instability, lesions of the labral-bicipital complex, subacromial impingement, and rotator cuff lesions and highlights the significance of imaging findings with a view to detection of recurrent lesions and postoperative complications in a multimodality approach.

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“…1,6 Conversely, the absence of contrast in the subacromial-subdeltoid space does not exclude a full-thickness tear because scar tissue might prevent contrast from extending through the entire defect. 10,32 The presence of a definitive gap in the tendon makes the diagnosis most definitive.…”

Section: Recurrent Rotator Cuff Tearmentioning

confidence: 99%

Complications of rotator cuff surgery—the role of post-operative imaging in patient care

Thakkar¹,

Thakkar²,

Srikumaran³

et al. 2014

BJR

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When pain or disability occurs after rotator cuff surgery, post-operative imaging is frequently performed. Post-operative complications and expected post-operative imaging findings in the shoulder are presented, with a focus on MRI, MR arthrography (MRA) and CT arthrography. MR and CT techniques are available to reduce image degradation secondary to surgical distortions of native anatomy and implant-related artefacts and to define complications after rotator cuff surgery. A useful approach to image the shoulder after surgery is the standard radiography, followed by MRI/MRA for patients with low "metal presence" and CT for patients who have a higher metal presence. However, for the assessment of patients who have undergone surgery for rotator cuff injuries, imaging findings should always be correlated with the clinical presentation because post-operative imaging abnormalities do not necessarily correlate with symptoms.The complexity of the anatomy and function of the rotator cuff makes the rotator cuff tendons vulnerable to considerable morbidity, often necessitating surgical intervention. Optimal management of rotator cuff abnormalities depends on a variety of factors, such as the presence and severity of an impingement, the degree of tendon damage and individual functional demands.1 The goals of rotator cuff surgery are to reduce pain, while simultaneously improving the function. The latter is accomplished by two main types of surgical procedures: (1) subacromial decompression surgery alone, typically with an acromioplasty and/or Mumford procedure (distal clavicular resection); and (2) repair of the rotator cuff tear (open or arthroscopic), which is almost always accompanied by a subacromial decompression.Post-operative imaging is performed when pain or disability occurs after a surgical procedure. Often, however, postoperative imaging is degraded by surgical distortions of the native anatomy and metallic artefacts related to implants. Nevertheless, it is imperative that clinicians have an accurate anatomical delineation of the operative site. It is also important for the radiologist to accurately diagnose complications that might occur after rotator cuff surgery to guide optimal treatment. Mansat et al 2 examined 40 articles reporting the results of open rotator cuff repairs and determined that the overall mean complication rate was 10.5%.The article addresses complications that occur after rotator cuff surgery and expected post-operative imaging findings, with a focus on MRI, MR arthrography (MRA) and CT arthrography (CTA). Because not all post-operative imaging findings result in disability or pain for the patient, we also emphasize our approach and experience regarding how best to define imaging abnormalities after rotator cuff surgery. IMAGING APPROACHA protocol for the imaging of the post-operative shoulder always begins with radiography of the shoulder. The purpose of the radiograph is not only to detect obvious osseous complications, but also to identify the type of surgical procedure performed ...

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MR imaging of the shoulder after surgery.

Cited by 94 publications

References 0 publications

Evolution of Nonoperatively Treated Symptomatic Isolated Full-Thickness Supraspinatus Tears

Evolution of Nonoperatively Treated Symptomatic Isolated Full-Thickness Supraspinatus Tears

Multimodality imaging of the postoperative shoulder

Complications of rotator cuff surgery—the role of post-operative imaging in patient care

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