Thursday, March 01, 2007

Acromion and Rotator Cuff Impingement

Review of Literature
The supraspinatus and caudal tilt views correlate significantly with distinct intraoperative measurements of acromial spur size. Kitay GS et al advocate the evaluation of both views for preoperative assessment of the acromial spur in the rotator cuff impingement syndrome.
J Shoulder Elbow Surg 1995 Nov-Dec;4(6):441-8

The acromial angle is an objective and fairly reproducible measure of anterior acromial shape. The angle is useful in identifying patients with a greater likelihood of having a rotator cuff tear and in distinguishing patients with primary impingement from those with instability.
AJR Am J Roentgenol 1995 Sep;165(3):609-13

Tendon tears and fatty muscle degeneration in the rotator cuff correlate with reduced acromiohumeral distance. Size of rotator cuff tear and degree of fatty degeneration of the infraspinatus muscle have the most pronounced influence on acromiohumeral distance.
AJR Am J Roentgenol 2006 Aug;187(2):376-82

2 comments:

dolby said...

FINDINGS; The patient has a typc-IT acromion. which is slightly laterally downslopitig with mtld-to-tnoderate aeromiodavicular joint degenerative changes seen. These findings may be contributing to clinical impingement syndrome. There is a moderate amount of fluid seen in the subacromial/subdeltoid bursa consistent with a moderate-to-marked bursitis.
The infraspinatus tendon appears intact. The supraspinatu? tendon appears thinned near its insertion at the anterior critical zone with some intermediate to increased signal intensity noted within, which is worrisome for a partial, if not complete, tear, A tear in the region of the rotator interval may be present. 5-10 mm retraction of the musculotendinous junction may be present. The subscapularis tendon appears intact as does the extracapsular segment of the long head of the biceps tendon. Slight thickening of the intraeapsular segment may be artifactuaJ versus represent a mild tendtnosis, There is a moderate effusion seen at the glenohumeral joint.
Limited visualization of the glenoid labrum demonstrates some intermediate to increased signal intensity along the base of the anterior labrum on the axial gradient-echo images. This is less obvious on the axial T2-weighted images and may, therefore, represent hyaline cartilage rather than a tear. Clinical correlation, however, would be recommended. The posterior labmm appears intact, Mild cystic degenerative changes are seen along the anteromedial aspect of the humeral
head.
CONCLUSIONS;
). Slightly laterally downsloping acromion with niild-to-moderate AC joint, degenerative changes seen. These findings may be contributing to clinical impingement syndrome.
Moderate-to-marked subacromial/subdeltoid bursitis with a moderate-sized effusion also seen at the glenohumeral
joint.
Bright signal is seen in the region of the supraspinatus tendon near it? insertion at the anterior critical zone, which is
worrisome for a partial, if not focal full thickness, tear. 5-10 mm retraction of the musculotendittous junction may be
present
Linear intermediate signal along the base of the anterior labrum on the axial gradient-echo images. This is not
readily apparent on the axial T2-weighted images and may, therefore, represent hyaline cartilage rather than a labral tear
- recommend clinical correlation.
Possible mild tcndinosis involving the intracapsular segment of the long head of the biceps tendon. Partial voluming
artifact however, may he contributing to this appearance.
Possible tear in the region of the rotator interval,
Mild cystic degenerative changes are seen along the anterornedial aspect of the humeral head.
I am a 53 old healthy in good physical shape female. I have suffered with the arm for 25 yrs but not this bad. Can this be healed without surgery.
please email me at nevaron7@aol.com

namaste, dolby

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