The Association between Radiographic Greater Tuberosity Cystic Change and Rotator Cuff Tears: A Study of 105 Consecutive Cases

Abstract

Background Cystic changes in the greater tuberosity of the humerus are common, and are often reported to be associated with rotator cuff tear or ageing. The present study aimed to assess whether cysts on plain radiograph of the shoulder are indicative of rotator cuff tears. Materials and methods One hundred and five consecutive patients with painful shoulders who underwent arthroscopic procedures were recruited prospectively. The observed radiographic cysts in the tuberosity were correlated with arthroscopic findings of their rotator cuff, as well as with other pathologies. Results Cysts appeared more often in shoulders with rotator cuff tears than in those without tears (p < 0.001). The overall positive predictive value for a patient with a painful shoulder in the presence humeral cysts was 68%. This rises to 85% if the patient is aged 60 years or older. Cysts occurred with similar probability in shoulders with or without superior labral tears, calcific tendinitis, impingement and frozen shoulder. Discussion Cystic changes in the greater tuberosity were closely associated with rotator cuff tears and age. When humeral cysts are detected on plain radiographs in a patient with a painful shoulder, the index of suspicion for rotator cuff tear should be high, particularly for those patients aged over 60 years.

Evidence‐based criteria for palaeopathological recognition: New methodology suggests that the rotator cuff condition will be amenable to reliable identification in the archeologic record

“…Chronic rotator cuff tears are associated with greater humeral tuberosity osteopenia (Cadet, Hsu, Levine, Bigliani, & Ahmad, ), but its prevalence and specificity are not established, and this has yet to be considered in paleopathological assessments. Focal greater tuberosity alterations have sometimes been referred to as cysts (Başar, Kanatlı, Cıtaker, & Bölükbaşı, ) because of their appearance on oblique radiologic views or CT/MRI slices (Pan, Mok, Tsiouri, & Chidambaram, ; Williams et al, ). They actually are surface disruptions related to tendon avulsion (Rothschild, ), distinguished by anatomical location from erosive disease (Resnick, ; Rothschild & Martin, ) and lack specificity (Williams et al, ).…”