Anterior versus posterior, and rim-rent rotator cuff tears: prevalence and MR sensitivity |
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Authors: | M J Tuite John R Turnbull John F Orwin |
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Institution: | (1) Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., E3/311 CSC, Madison, WI 53792–3252, USA, US |
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Abstract: | Purpose. To determine the relative distribution of the locations of rotator cuff tears, and the sensitivity of anterior versus posterior
tears on MR images. Patients and methods. We identified 110 consecutive patients who had a shoulder MR and either a partial-thickness or a small full-thickness rotator
cuff tear diagnosed at arthroscopy. From the arthroscopy videotapes, we classified the tears as centered in the anterior or
posterior half of the cuff, and as either in the critical zone or adjacent to the bony insertion. The original MR interpretation
was compared with the arthroscopic findings. MR sensitivity and patient age were compared between patients with tears in the
anterior and posterior halves of the cuff. In addition, in patients with partial tears less than 2 cm in diameter, an age
comparison between those with tears in the critical zone and those with articular surface tears adjacent to the bony insertion
(rim-rent tear) was performed. Results. The tear was centered in the anterior half of the rotator cuff in 79% of the patients younger than 36 years old, and in 89%
of the patients 36 years old and over. The average age of the patients with tears in the anterior half (44 years) was not
significantly different from the average age of those with posterior tears (40 years)(P=0.23). The sensitivity of MR for anterior tears was 0.69, and for posterior tears it was 0.56 (P=0.17). The average age of the 9 patients with rim-rent tears was 31 years, while that of the 28 patients with similarly-sized
partial tears not involving the insertion was 40 years old (P=0.048). Five of the nine rim-rent tears (0.56) were interpreted correctly on the original MR report; two of the other tears
were misinterpreted as intratendinous fluid but were diagnosable in retrospect. Conclusion. Even in patients less than 36 years old, most partial and small full-thickness rotator cuff tears are centered in the anterior
half of the supraspinatus. Although our figure for MR sensitivity for these tears is lower than in recent articles, we found
no significant difference between the sensitivity of MR for diagnosing posterior tears versus tears in the anterior half of
the supraspinatus tendon. Rim-rent tears can be mistaken for intratendinous signal, and should be carefully looked for in
younger patients with shoulder pain. |
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Keywords: | Shoulder injuries Shoulder MR Arthroscopy |
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