The coracoacromial arch: MR evaluation and correlation with rotator cuff pathology |
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Authors: | Timothy E Farley MD Christian H Neumann MD PhD Lynne S Steinbach MD Steve A Petersen MD |
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Institution: | (1) Department of Radiology, Desert Hospital, 1150 N. Indian Canyon Drive, 92262, CA, Palm Springs, USA;(2) Department of Diagnostic Radiology, Florida Hospital, Orlando, Florida, USA;(3) Desert Hospital, Department of Radiology, Palm Springs, California, USA;(4) Department of Radiology, University of California San Francisco, San Francisco, California, USA;(5) Department of Orthopedic Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA |
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Abstract: | The relative prevalence of various acromial shapes, appearance of the coracoacromial ligament and enthesophytes along the
inferior aspect of the acromioclavicular joint in patients with and without rotator cuff tears were evaluated. Of 76 patients
with clinical instability and impingement, 31 had a normal rotator cuff and 45 demonstrated a partial or full tear of the
supraspinatus tendon at surgery. Results were compared with those from magnetic resonance (MR) scans of 57 asymptomatic volunteers.
Of the 45 patients with a supraspinatus tear, 38% (17) had a flat acromial undersurface (type I), 40% (18) had a concave acromial
undersurface (type II), 18% (8) had an anteriorly hooked acromion (type III), and 4% (2) had an inferiorly convex acromion
(type IV). Among the 31 patients with a normal rotator cuff at surgery and the 57 asymptomatic volunteers, the respective
prevalences of the type I acromion were 39% (12) and 44% (25), of type II 48% (15) and 35% (20), type III 3% (1) and 12% (7),
and type IV 10% (3) and 9% (5). Shoulders with surgically proven rotator cuff tears showed a tendential association with a
type III acromion (8/45) and statistically significant associations with a thickened coracoacromial ligament (17/45) and acromioclavicular
enthesophytes (18/45). For the association between inferiorly directed acromioclavicular joint enthesophytes and rotator cuff
tears, age appears to be a confounding factor. The type IV acromion, newly classified by this study, does not have a recognizable
association with rotator cuff tears. Assessment of the osseous-ligamentous coracoacromial outlet by may prove helpful to the
orthopedic surgeon in patients for whom surgical decompression is contemplated. |
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Keywords: | Shoulder MR Rotator cuff tear Acromion Subacromial outlet |
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