Dynamic Three-Dimensional Shoulder Mri during Active Motion for Investigation of Rotator Cuff Diseases

Christine Tempelaere, Jérome Pierrart, Marie-Martine Lefèvre-Colau, Valérie Vuillemin, Charles-André Cuénod, Ulrich Hansen, Olivier Mir, Wafa Skalli, Thomas Gregory, Christine Tempelaere, Jérome Pierrart, Marie-Martine Lefèvre-Colau, Valérie Vuillemin, Charles-André Cuénod, Ulrich Hansen, Olivier Mir, Wafa Skalli, Thomas Gregory

Abstract

Background: MRI is the standard methodology in diagnosis of rotator cuff diseases. However, many patients continue to have pain despite treatment, and MRI of a static unloaded shoulder seems insufficient for best diagnosis and treatment. This study evaluated if Dynamic MRI provides novel kinematic data that can be used to improve the understanding, diagnosis and best treatment of rotator cuff diseases.

Methods: Dynamic MRI provided real-time 3D image series and was used to measure changes in the width of subacromial space, superior-inferior translation and anterior-posterior translation of the humeral head relative to the glenoid during active abduction. These measures were investigated for consistency with the rotator cuff diseases classifications from standard MRI.

Results: The study included: 4 shoulders with massive rotator cuff tears, 5 shoulders with an isolated full-thickness supraspinatus tear, 5 shoulders with tendinopathy and 6 normal shoulders. A change in the width of subacromial space greater than 4mm differentiated between rotator cuff diseases with tendon tears (massive cuff tears and supraspinatus tear) and without tears (tendinopathy) (p = 0.012). The range of the superior-inferior translation was higher in the massive cuff tears group (6.4mm) than in normals (3.4mm) (p = 0.02). The range of the anterior-posterior translation was higher in the massive cuff tears (9.2 mm) and supraspinatus tear (9.3 mm) shoulders compared to normals (3.5mm) and tendinopathy (4.8mm) shoulders (p = 0.05).

Conclusion: The Dynamic MRI enabled a novel measure; 'Looseness', i.e. the translation of the humeral head on the glenoid during an abduction cycle. Looseness was better able at differentiating different forms of rotator cuff disease than a simple static measure of relative glenohumeral position.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. The width of the subacromial…
Fig 1. The width of the subacromial space during abduction motion.
Fig 2. Translation of the humeral head…
Fig 2. Translation of the humeral head along the Y-axis (superior-inferior direction) of glenoid coordinate system
Fig 3. Translation of the humeral head…
Fig 3. Translation of the humeral head along the X-axis (anterior-posterior direction) of glenoid coordinate system
Fig 4. Monitoring of the humeral head…
Fig 4. Monitoring of the humeral head center projection on to the glenoid for each of the 14 shoulders during abduction.
The size of the glenoids was standardized so that each fit with a circle of 200% diameter (-100% to +100%). The locations of the humeral head center projections on to the glenoid are expressed in percentile. Fig 4A, massive rotator cuff tear; Fig 4B, Supraspinatus tear; Fig 4C, Tendinopathy alone; Fig 4D, normal shoulders.

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Source: PubMed

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