THE RELATIONSHIP BETWEEN THE MORPHOMETRIC PARAMETERS OF SCAPULA AND SUPRASPINATUS TENDINITIS

OBJECTIVE: Tendinitis is one of the most frequent shoulder lesions. The aim of this study is to evaluate the correlation of the radiological parameters including critical shoulder angle (CSA), glenoid inclination (GI) and acromion index (AI) with supraspinatus tendinitis. MATERIAL AND METHODS: Seventy-four patients (47 men, 27 women, mean age 29±5.2 (range 18-40)) were included in the study. Two groups were formed as Group I (n=33) and Group II (n=41) according to supraspinatus tendon intensity revealed by shoulder magnetic resonance images. Critical shoulder angle, glenoid inclination and acromion index parameters were measured on shoulder radiographs obtained in neutral position. The relationship of the radiologic parameters and the presence of supraspinatus tendinitis were evaluated. RESULTS: The mean CSA was 37.9°, the mean GI was 17.2°, and the mean AI was 0.8 in Group I. The mean CSA was 38.3°, the mean GI was 17.1°, and the mean AI was 0.8 in Group II. No statistically significant difference was found between the groups. The CSA values of the women were statistically significantly higher than that of the men (p=0.04). CONCLUSIONS: Higher CSA values are found to be associated with the risk of rotator cuff tear and lower CSA values with osteoarthritis. Higher angles are associated with increased risk of supraspinatus tendinitis tear. Supraspinatus tendinitis is not associated with the morphometric parameters including CSA, AI and GI. New morphometric parameters should be identified and their relation with supraspinatus tendinitis should be investigated for early diagnosis.

SUPRASPINATUS TENDİNİTİ VE SKAPULA MORFOMETRİK PARAMETRELERİ ARASINDAKİ İLİŞKİ

AMAÇ:Tendinit en sık görülen omuz lezyonlarından biridir. Bu çalışmanın amacı, kritik omuz açısı (KOA), glenoid eğimi (GI) ve akromiyon indeksi (AI) dahil olmak üzere radyolojik parametrelerin supraspinatus tendiniti ile korelasyonunu değerlendirmektir. GEREÇ VE YÖNTEM: Çalışmaya 72 hasta (47 erkek, 27 kadın, yaş ortalaması 29 ± 5.2 (18-40)) dahil edildi. Omuz manyetik rezonans görüntüleri ;supraspinatus tendonundaki sinyal artışına göre normal olan Grup I (n = 33) ve yüksek olan Grup II (n = 41) olmak üzere iki gruba ayrıldı.Nötral pozisyonda elde edilen omuz radyografilerinde kritik omuz açısı, glenoid eğim ve akromiyon indeksiparametreleri ölçüldü. Radyolojik parametreler ile supraspinatus tendinit varlığı arasındaki ilişki değerlendirildi. BULGULAR: Grup I’de Ortalama KOA 37.9°, ortalama GI 17.2° ve ortalama AI 0.8 idi. Grup II’de Ortalama KOA 38.3°, ortalama GI 17.1° ve ortalama AI 0.8 idi. Gruplar arasında istatistiksel olarak anlamlı bir fark bulunmadı. Kadınların KOA değerleri erkeklerden istatistiksel olarak anlamlı derecede yüksekti (p = 0.04). SONUÇ: Yüksek KOA değerlerinin rotator manşet yırtığı ve düşük KOA değerlerinin osteoartrit ile ilişkili olduğu bulunmuştur. Çalışmamızda supraspinatus tendinit ile KOA, AI ve GI parametreleri arasında ilişki saptamadık. Supraspinatusun erken tanısında kullanılmak üzere yeni morfometrik parametrelere ihtiyaç vardır.

PDF

___

1. Blevins FT .Rotator Cuff pathology in athletes. Sports Med 1997; 24:205-220.

2. Jo CH, Shin WH, Park JW, Shin JS, Kim JE. Degree of tendon degeneration and stage of rotator cuff disease. Knee Surg Sports Traumatol Arthrosc. 2017;25:2100-2108.

3. Bigliani LU, Ticker JB, Flatow EL, Soslowsky LJ, Mow VC. The relationship of acromial architecture to rotator cuff disease. Clin Sports Med. 1991;10:823-838.

4. Davidson PA, Elattrache NS, Jobe CM, Jobe FW. Rotator cuff and posterior-superior glenoid labrum injury associated with increased glenohumeral motion: a new site of impingement. J Shoulder Elbow Surg. 1995;4:384-390.

5. Hughes RE, Bryant CR, Hall JM, Wening J, Huston LJ, Kuhn JE, Carpenter JE, Blasier RB. Glenoid inclination is associated with full-thickness rotator cuff tears. Clin Orthop Relat Res. 2003;407:86-91.

6. Kim JR, Ryu KJ, Hong IT, Kim BK, Kim JH. Can a high acromion index predict rotator cuff tears? Int Orthop. 2012;36:1019-1024.

7. Neer CS .Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am 1972;54:41-50.

8. Nove-Josserand L, Edwards TB, O’Connor DP, Walch G. The acromiohumeral and coracohumeral intervals are abnormalin rotator cuff tears with muscular fatty degeneration. Clin Orthop Relat Res. 2005;433:90-96.

9. Nyffeler RW, Werner CM, Sukthankar A, Schmid MR, Gerber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. 2006;88:800-805.

10. Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint? A radiological study of the critical shoulder angle. Bone Joint J. 2013;95:935–941.

11. Viehöfer AF, Snedeker JG, Baumgartner D.Glenohumeral Joint Reaction Forces Increase With Critical Shoulder Angles Representative of Osteoarthritis-A Biomechanical Analysis. J Orthop Res 2016;34:1047-1052.

12. Gerber C, Snedeker JG, Baumgartner D, Viehöfer AF. Supraspinatus Tendon Load During Abduction Is Dependent on the Size of the Critical Shoulder Angle: A Biomechanical Analysis. J Orthop Res. 2014;32:952-957.

13. Viehöfer AF, Gerber C, Favre P, Bachmann E, Snedeker JG. A Larger Critical Shoulder Angle Requires More Rotator Cuff Activity to Preserve Joint Stability. J Orthop Res. 2016;34:961-968.

14. Bouaicha S, Ehrmann C, Slankamenac K, Regan WD, Moor BK. Comparison of the critical shoulder angle in radiographs and computed tomography. Skeletal Radiol. 2014; 43:1053-1056.

15. Cherchi L, Ciornohac JF, Godet J, Clavert P, Kempf JF. Critical shoulder angle: Measurement reproducibility and correlation with rotator cuff tendon tears. Orthop Traumatol Surg Res. 2016;102:559-562.

16. Hermans J, Luime JJ, Meuffels DE, Reijman M, Simel DL,Bierma-Zeinstra SM. Does this patient with shoulder pain have rotator cuff disease?: The Rational Clinical Examination systematic review. JAMA. 2013;310:837-847.

17. Papadonikolakis A, McKenna M, Warme W, Martin BI, Matsen FA 3rd. Published evidence relevant to the diagnosis of impingement syndrome of the shoulder. J Bone Joint Surg Am. 2011;93;1827-1832.

18. Bauer S, Wang A, Butler R, Fallon M, Nairn R, Budgeon C, Breidahl W, Zheng MH. Reliability of a 3 T MRI protocol for objective grading of supraspinatus tendonosis and partial thickness tears . J Orthop Surg Res. 2014;9:128.

19. Bjarnison AO, Sorensen TJ, Kallemose T, Barfod KW. The critical shoulder angle is associated with osteo - arthritis in the shoulder but not rotator cuff tears: a ret - rospective case-control study. J Shoulder Elbow Surg. 2017;26:2097-2102.

20. Spiegl UJ, Horan MP, Smith SW, Ho CP, Millett PJ. The critical shoulder angle is associated with rotator cuff tears and shoulder osteoarthritis and is better assessed with radiographs over MRI. Knee Surg Sports Traumatol Arth - rosc. 2016:24:2244-2251.

21. Daggett M, Werner B, Collin P, Gauci MO, Chaoui J, Walch G. Correlation between glenoid inclination and critical shoulder angle: a radiographic and computed to - mography study. J Shoulder Elbow Surg. 2015;24:1948– 1953.

22. Gomide LC, Carmo TCD, Bergo GHM, Oliveira GA, Ma - cedo IS. Relationship between the critical shoulder angle and the development of rotator cuff lesions: a retrospec - tive epidemiological study Rev Bras Ortop. 2017;52:423- 427.

23. Miswan M, Saman MS, Hui TS, Al-Fayyadh MZ, Ali MR, Min NW. Correlation between anatomy of the scapula and the incidence of rotator cuff tear and glenohume - ral osteoarthritis via radiological study. J Orthop Surg. 2017;25:1-5.

24. Blonna D, Giani A, Bellato E, Mattei L, Calo M, Rossi R, Castoldi F. Predominance of the critical shoulder angle in the pathogenesis of degenerative diseases of the shoul - der. J Shoulder Elbow Surg. 2016;25:1328-1336.

25. Hanciau FA, da Silva MA, Martins FS, Ogliari A. Associ - ation clinical-radiographic of the acromion índex and the lateral acromion angle. Rev Bras Ortop. 2015;47:730-735.

26. Hamid N, Omid R, Yamaguchi K, Steger-May K, Stobbs G,Keener JD. Relationship of radiographic acromial cha - racteristics and rotator cuff disease: a prospective inves - tigation of clinical, radiographic, and sonographic findin - gs. J Shoulder Elbow Surg. 2012;21:1289-1298.

27. Tétreault P, Krueger A, Zurakowski D, Gerber C. Glenoid version and rotator cuff tears. J Orthop Res. 2004;22:202-207.

28. Gu G, Yu MY.Imaging features and clinical significance of the acromion morphological variations. J Nov Physio - ther .2013;S2:003.

29. Engelhardt C, Farron A, Becce F, Place N, Pioletti DP, Terrier A. Effects of glenoid inclination and acromion in - dex on humeral head translation and glenoid articular cartilage strain. J Shoulder Elbow Surg. 2017;26:157-164.

30. Naidoo N, Lazarus L, Van Tongel A, Osman SA, Sat - yapal KS. Predictors of Shoulder Degeneration in the KwaZulu-Natal Population of South Africa. Int J Morphol. 2018:36;92-96.