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PubMed1984

Rotator cuff tears associated with os acromiale.

We studied the cases of eight patients, one with bilateral involvement, who had a rotator cuff tear and an associated lesion delineated roentgenographically - a separate fragment of the acromion that we believe to be an ununited ossification center of the acromion (os acromiale). In reviewing the literature, we found no mention of an association between a rotator cuff tear and os acromiale. It is highly unlikely that such an association is coincidental because it appears that in our patients abnormal motion existed through the site of fibrous union of the acromion and may have contributed to the impingement of the acromion on the rotator cuff. Repair of the rotator cuff with removal of the loose fragment of acromion was done in the six patients who had operative treatment.

Acromion↗
PubMed1995

[Role of the subacromial space on development of the impingement syndrome. I].

In the first part of the study reported in this paper the anatomy of 150 scapulae was studied to find out whether variation in the subacromial space might cause impingement syndrome. Sixteen different parameters, including various angles, size and shape of the acromion and the coracoid process, and length of the coracoacromial ligament and the acromion, were measured. Soft tissue was completely removed from the bone, so that no statement on the rotator cuff was possible. The data were processed using the Tukey LSD test. A statistically significant correlation between the size of the shoulder blade and the length of the acromion and the coracoacromial ligament was found. The shape of the coracoid process showed more individual variations, and no correlation with the size of the bony scapula was found. The shape of the subacromial space was obtained by using four different bony landmarks (acromial angle, tip of the anterior rim of the acromion, tip of the coracoid process and supraglenoid tubercle). Three different types were found: a "rhomboid" in 103 cases, an approximate "kite" shape in 35 cases, and a triangle in 12 cases. The rhomboid form means a larger plane surface, so that the rotator cuff can glide more smoothly than with the other types. The different shapes of the subacromial space did not influence the slope of the acromion in the scapular plane.

Acromion↗
PubMed1995

[Role of the subacromial space on development of the impingement syndrome. II].

Twenty-five patients with suspected impingement syndrome on the basis of clinical examination were evaluated by magnetic resonance imaging (MRI). In paracoronal and parasagittal planes, different measurements of bony structures of the subacromial space and of the glenoid joint were performed, as in the anatomical study reported in the companion paper. A healthy, age-and sex-matched group of 25 persons underwent the same MRI-procedure and the results were compared with those in the patients. Ruptures of the rotator cuff were excluded by means of standard X-rays, physical examination, and ultrasound. The comparison revealed a highly significant difference between the sizes of the subacromial space. Healthy persons had a space that was larger by more than one third than that of the patients. Other parameters did not differ significantly between the two groups. In a further part of the study the insertion zone of the coracoacromial ligament into the undersurface of the acromion was histologically studied in 24 autopsy specimens. Different staining techniques were used to find out whether microscopic changes occur during different stages of life. Cartilage without bone formation of the acromion was found in children. In adult specimens bony projections of the undersurface of the acromion and thickening of the surrounding fibrocartilage were found, but there was no correlation between ageing and these changes. However, in patients suffering from impingement syndrome the subacromial space is reduced. Acromioplasty enlarges the space by resection of the anterior part of the acromion. Bony spurs on the acromion and a thickening of the fibrocartilaginous layer are not degenerative changes, but they are caused by increased tensile strength of the coracoacromial ligament and are not influenced by age.

Acromion↗
PubMed1997

[Trapezius transfer in deltoid paralysis].

In most cases the genesis of brachial plexus palsy is traumatic, often because of bike accidents. If physiotherapy and neurosurgical procedures such as nerve repair do not have the desired outcome, muscle transfer operations are possible. The results of our favored transfer of the trapezius muscle to compensate paralysis of the deltoid muscle will be presented. Preoperatively radiological, clinical and electromyographic examinations are necessary. Our results are based upon the clinical and radiological check ups and the subjective assessment of the patients. Thirty-one patients (7 female, 24 male) underwent a trapezius transfer between March 1994 and December 1996. The average age was 29 years (range 18-46 years). We performed the operations using a modification of Saha's technique. With the patient in lateral decubitus position and protection of the opposite plexus, a sagital skin incision is the first step, followed by the preparation of trapezius and deltoid muscle as well as the bony parts of the shoulder (acromion, clavicle, scapular spine). The deltoid origin is cut from the lateral third of the clavicle, the acromion and the lateral half of the scapular spine. The next step is transection of the roof of the acromion and the lateral clavicle. After elevation of the remaining trapezius insertions from the clavicle and scapular spine, the proximal humerus is exposured by splitting the partly detached deltoid muscle longitudinally. Then the acromion fragment and humerus are prepared for the bone-to-bone contact. In 90 degrees of abduction the acromion fragment with its trapezius insertion is transferred and fixed to the humerus with two 4.5-mm screws. Finally the deltoid is sutured on the top of the trapezius and the skin is closed over two suction drains. Postoperatively we immobilize the operated arm in an abduction support for 6 weeks. The physiotherapy program starts on the first postoperative day with active training of elbow, hand and fingers and electrostimulation of the transferred trapezius muscle. Six weeks after the procedure we take an X-ray and start with progressive adduction of the arm. The preoperative subluxation of the humeral head was abolished in all cases. We achieved an average increase of active abduction from 7.3 degrees (range 0-45 degrees) preoperatively to 39.2 degrees (range 25 degrees-80 degrees) 1 year after the operation; the increase of forward flexion was from 20 degrees (range 0 degrees-85 degrees) to 43 degrees (range 20 degrees-90 degrees). All patients were satisfied with the improvement of stability and function of the operated shoulder. Finally we can conclude that the trapezius transfer for flail shoulder gives a satisfactory outcome regarding shoulder function and stability as well as the subjective situation of the patients.

Adolescent↗
PubMed2003

The relationship between clinical outcomes and the amount of arthroscopic acromial resection.

PURPOSE: In 47 consecutive patients who had a shoulder impingement syndrome treated by arthroscopic subacromial decompression, we compared the functional outcome with the amount of the acromion resection. TYPE OF STUDY: Prospective study. METHODS: The inclusion criteria for patient selection was a chronic impingement syndrome unresolved by conservative treatment with an intact rotator cuff or with an irreparable rupture of the rotator cuff. The assessment was performed with the scoring system of Constant preoperatively and postoperatively. Quantitative measurements of the acromion resection were made by comparing preoperative and postoperative anteroposterior radiographic views, standardized under fluoroscopic control in order to become reproducible and comparable. There were 39 patients (41 shoulders) available for follow-up at 37 months. RESULTS: The condition of the shoulder, concerning pain, motion and activities, was improved at the time of follow-up, the mean gain of the total functional score was 29 points/100. Age, side, activity, duration of pain before procedure and cuff statement had no influence on preoperative and postoperative Constant's score. The difference between preoperative and postoperative measurements of anterior acromion protuberance was significant. There was no correlation between the amount of the acromion resection and the improvement of Constant's score (P =.84). CONCLUSIONS: The origin of impingement syndrome is multi-factorial, and efficiency of arthroscopic decompression may not be only due to the amount of acromion resection. From these results and a literature review, this study analyzes several morphologic factors, which could explain the good results of arthroscopic subacromial decompression in impingement syndrome.

Acromioclavicular Joint↗
PubMedDate not supplied

[3-dimensional image analysis of the shoulder joint--a new method for characterizing parameters of shoulder joint function].

OBJECTIVE: An exact assessment of shoulder movement is of special importance both in the diagnosis of and in the therapy for different shoulder diseases. Therefore, we developed a feasible method for the analysis of shoulder movement. METHODS: On the basis of an ELITE system and 6 skin markers (marker positions. acromion, humerus, olecranon, proc. styloideus ulnae, cervical and thoracic spine), movement analysis was performed during continuous abduction of the arm over 15 s. With the help of a purpose made software we determined the exact angle of abduction and, in addition, the acceleration (+aAC) and the deceleration (-aAC) of the acromion. We evaluated 12 normal subjects (10 male, 2 female, average age 29 yrs) without shoulder conditions and 8 patients (6 male, 2 female, average age 46 yrs.) with unilateral impingement syndrome stage II according to Neer. RESULTS: In addition to a significantly diminished abduction ability in patients with impingement syndrome, our results also revealed significantly decreased acceleration values for the acromion in impingement patients. In contrast, deceleration values for the acromion were not altered in patients with impingement syndrome. CONCLUSION: The presented method allows exact measurements of shoulder movement. In addition, measurements of acromion acceleration and deceleration seem to offer two parameters for the assessment of shoulder function in pathological conditions. Further investigations are required to prove the advantages and limitations of this method.

Adult↗
PubMed2005

Anatomic safe zone of pin insertion point for distal clavicle fixation.

Clavicle fracture is the most common childhood fracture and one of the most common fractures in adults. Only some types of distal clavicular fractures, and dislocation of the acromioclavicular joint, require internal fixation. Many surgeons prefer closed pinning; however, the difficulty inserting many of the various kinds of pins from acromion into the medullary canal, of the distal clavicle, means the likelihood of iatrogenic complications from repeated drilling is heightened. The purpose of the present study was to establish what would be the optimum insertion point and direction for safe intramedullary pinning of the distal clavicle. Embalmed cadaveric shoulders (32) were studied. A bone window was created at the distal one-thirds of the clavicle, approximately 1.5 cm medial from the conoid tuberosity - as wide as could be freely, retrogradely drilled into the medullary canal of the distal clavicle. A 2.0-mm Kirschner wire was inserted until it penetrated the acromion. The point of emergence was recorded as ratio compared with the acromial width and length in coronal and sagittal planes, respectively. K-wire directions were measured as the angle between the K-wire and the reference line from the anterosuperior tubercle of the clavicle to the anterior angle of the acromion. The process was repeated until the acromion fractured 304 drillings were performed on 32 specimens. The length of the sagittal vs.coronal pin insertion point from the anterior vs. lateral borders of the acromion divided by its length vs. width averaged 0.325 +/- 0.04 and 0.397 +/- 0.09, respectively. The angle of the K-wire and the reference was 7.69 +/- 3.04 and 14.59 +/- 4.34 degrees in the coronal and horizontal planes, respectively. At 8 and 10 drillings survival was 0.72 (95%CI: 0.53-0.84) and 0.41 (95%CI: 0.24-0.57), respectively. The optimum pin inserting point for fixation of distal clavicle fracture and acromioclavicular joint dislocation is 32.5% and 39.7% of acromial length and width, respectively. If a 2.0-mm K-wire is used for fixation, drilling should not be repeated drilled more than 8 times to avoid sudden, high risk iatrogenic acromial fracture.

Bone Nails↗
PubMed1985

[Age-related characteristics of the human acromioclavicular joint].

By birth in the acromioclavicular joint the acromial end of the clavicle is osseous, and the acromion of the scapula is cartilaginous. The most intensive formation of the relief and configuration of the articular surfaces of the joint occurs from 1 to 3 years of age. In mature persons the form of the articular surface of the acromial end of the clavicle is often oval and that of the acromion of the scapula--ellipsoid. In newborns the areas of the articular surfaces are nearly equal. The area of the articular surface of the acromial end of the clavicle is significantly more than that of the acromion of the scapula during the periods from 1 to 3, from 13 to 17 and from 21 to 30 years of age. The articular cleft is revealed in the roentgenograms by 17 years of age, when synostosis process of the acromion of the scapula is completed. The thickness of the articular cartilage at different poles of the articular surfaces from birth up to 70 years of age is not equal and therefore it is possible to judge about nonequivalent functional loading on different areas of the articular cartilage. The articular cartilage of the acromial end of the clavicle from birth to 16 years of age is hyaline, after 17 years of age, they acquire the structure of the fibrous cartilage. In the articular cartilage of the acromion of the scapula, this rearrangement is realized more slowly: its fibrous structure is revealed after 23-24 years of age. Involutional changes in the joint are revealed during the fourth decade.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromioclavicular Joint↗
PubMed2005

Innervation of biceps brachii and brachialis: Anatomical and surgical approach.

This study describes the anatomy of the musculocutaneous nerve (MCN) in the middle and lower thirds of the arm, with special reference to the motor branches to the biceps and brachialis muscles, given their importance in certain clinical, particularly surgical, procedures. In each dissection (46 upper limbs) we recorded the course of the MCN and its variations, and the number, type of distribution pattern and length of the motor branches to the biceps brachii and brachialis muscles. We also recorded the position at which those branches arose from the MCN trunk. We found three branching patterns for biceps brachii: 1) one branch (60.5%); 2) two branches, one for each biceps head (27.9%); and 3) two branches, one for the two biceps heads and one for the common belly (11.6%). The mean distance between the acromion and the motor branches to biceps brachii was 133.8 mm, 45.3% of the acromion-lateral epicondyle distance. The mean length of those branches was 31.2 mm. We found two branching patterns for brachialis: 1) one branch (72.1%); and 2) two branches (27.9%). These motor nerves to brachialis arose from the MCN at a mean distance of 185.3 mm, 61.5% of the acromion-lateral epicondyle distance, and their average length was 33.0 mm. The data were expressed as the percentage of the distance between the acromion and the lateral epicondyle of the humerus, to make their clinical use easy and to avoid errors caused by anthropometric differences.

Acromion↗
PubMed1999

Subacromial space width changes during abduction and rotation--a 3-D MR imaging study.

The objectives of this study were to determine systematic changes of the normal subacromial space width during abduction and rotation, and to analyze the spatial relationship of the supraspinatus muscle with the acromion and clavicle. 12 healthy volunteers were imaged by an open MR scanner in 5 different positions of abduction and in 3 positions of rotation. After three dimensional (3D) reconstruction and 3D Euclidian distance transformation, the minimal spatial distances between the humerus and the acromion and the humerus and clavicle were computed. The minimal acromio-humeral distance decreased significantly from 30 degrees of abduction (mean 7.0 mm +/- 1.6 mm) to 120 degrees (mean 3.9 mm; +/- 1.8 mm; p < 0.0001). At 30 degrees, the minimal distance penetrated the supraspinatus, whereas at 120 degrees it was always located lateral to the supraspinatus tendon. At 90 degrees with internal rotation (7.6 mm, +/- 2.3 mm) the minimal acromio-humeral distance was larger than in neutral rotation (5.4 mm, +/- 2.3 mm) or external rotation (4.4 mm, +/- 2.2 mm; p < 0.05), but it penetrated the supraspinatus tendon at its most vulnerable part, reaching the acromion at its anterior inferior border. We conclude that the subacromial space width changes during abduction and rotation and that the supraspinatus is in closest contact to the anterior inferior border of the acromion in 90 degrees of abduction with 45 degrees internal rotation. These values obtained in volunteers can be used as a basis for further investigations in patients with the impingement syndrome.

Acromion↗
PubMed2004

Relation between adhesive capsulitis and acromial morphology.

PURPOSE: The purpose of this study was to determine whether a relationship existed between primary adhesive capsulitis and acromial morphology. TYPE OF STUDY: Case control series. METHODS: Between January 1999 and June 2002, a total of 100 patients (104 shoulders) were diagnosed with adhesive capsulitis. A retrospective chart review was performed of all of these patients. A total of 67 patients (69 shoulders) met the inclusion criteria of primary adhesive capsulitis. The patients' range of motion and signs of impingement were documented. The supraspinatus outlet radiographs were assessed, and each patient's acromial morphology was graded as type I, II, or III. A case control group of 53 patients (58 shoulders) was assessed to determine the validity of our results. This group consisted of a series of new patients that were referred to the clinic during February 2003 for assessment of their shoulders. RESULTS: The average age of the patients in the adhesive capsulitis group was 52.5 +/- 7.6 years, with 34 women (50.7%) and 33 men (49.3%). The control group had an average age of 51.1 +/- 16.9 years in a series of 19 (35.8%) women and 34 (64.2%) men. The average range of motion was 98.0 degrees +/- 23.5 degrees of forward elevation, and 91.9 degrees +/- 24.3 degrees of abduction. The forward elevation was 165.5 degrees +/- 15.3 degrees and the abduction was 162.4 degrees +/- 18.4 degrees. The predominant acromial morphology in both groups in this study was a type II acromion (75.4% in the adhesive capsulitis group and 74.1% in the control group). The chi-square analysis within the specific groups showed statistically significant differences in the number of type II compared with type I acromions, and type II compared with type III acromions in both series. However, statistical analysis showed no significant difference between the various acromial types when comparing the adhesive capsulitis group with the control group. CONCLUSIONS: Our results show a significant number of patients with both adhesive capsulitis and, in the control group, type II acromions. We found no statistical difference between these 2 groups. Based on our results, the intrinsic trauma that occurs from subacromial space narrowing caused by the anterior acromial shape, cannot be implicated as the cause of primary adhesive capsulitis. LEVEL OF EVIDENCE: Level III, case control study.

Acromion↗
PubMedDate not supplied

Acromial shapes and extension of rotator cuff tears: magnetic resonance imaging evaluation.

Magnetic resonance imaging makes it possible to inspect the status of the rotator cuff and the shape of the acromion. To clarify the relationship between acromial shapes and rotator cuff tears, we evaluated magnetic resonance images obtained in 192 shoulders. We classified the acromial shapes into 3 types: type I (flat), type II (curved), and type III (hooked). Among a group of 91 shoulders with rotator cuff tears, 33 (36.3%) were type I, 22 (24.2%) type II, and 36 (39.6%) type III. The size of rotator cuff tears in type III acromions was significantly larger than in type I or II acromions. Comparison of the incidence of each acromial shape between groups of specimens with and without rotator cuff tears revealed no significant differences. We suggest that whereas acromial shapes have a bearing on the extent of rotator cuff tears, the correlation between rotator cuff tears and a type III acromion is not as strong as has been suggested in the literature.

Acromion↗
PubMed2001

Supraspinatus outlet view in the diagnosis of stages II and III impingement syndrome.

PURPOSE: To compare supraspinatus outlet view (SOV) findings at different stages of the impingement syndrome (IS) with findings in asymptomatic age- and sex-matched controls. MATERIAL AND METHODS: Pre-operative SOVs were obtained of 37 shoulders of patients scheduled for unilateral open repair of a full-thickness rotator cuff tear (stage III IS) and 74 shoulders of patients scheduled for open (n=46) or arthroscopic (n=28) acromioplasty for tendinitis (stage II IS). Each view of a patient's shoulder was paired with a control view obtained from an age- and sex-matched person with no shoulder problems (n=111). RESULTS: There were no significant differences in acromial morphology as evaluated on the scale devised by BIGLIANI et al. or in the tilt, slope or length of the acromion between the study groups and their controls. However, hooked acromion seemed to be more common in the patients. The thickness of the anterior part of the acromion at the tendinitis stage and the acromial angle at the tear stage of IS were the only parameters that showed significant differences between patients and controls. CONCLUSION: Variation of the morphology of the acromion as evaluated on a basis of the SOV is associated with IS, but the association is weak and its value in the diagnosis of IS is therefore only as an adjunctive to other diagnostic modalities.

Acromion↗
PubMed1997

The anatomy of the anterior origin of the deltoid.

We studied the origin of the anterior deltoid from the lateral third of the clavicle and the leading anterior edge of the acromion in 18 cadaver shoulders by anatomical and histological methods. The main origin of the deltoid was from the superior surface of the anterior acromion, but muscle and tendinous attachments were also seen on the entire anterior surface of the acromion, its anteroinferior surface and on the whole width of the anterior surface of the clavicle. Mock arthroscopic acromioplasty was shown to detach deltoid fibres from the anterior surfaces, leaving the superior attachment in continuity. Potentially, arthroscopic subacromial and clavicular resection can detach deltoid fibres originating from the anterior and anteroinferior surfaces of the acromion and clavicle and thus weaken the anterior deltoid.

Acromion↗
PubMed2000

Os acromiale: frequency, anatomy, and clinical implications.

BACKGROUND: Os acromiale is present when the anterior portion of the acromion has one or more separate ossicles. Its frequency has been documented, in radiographic and anatomical studies, to be between 1 and 15 percent. Reports of os acromiale associated with subacromial pathology have been cited to imply that this entity is a cause of subacromial impingement; however, no study has demonstrated an increased frequency of os acromiale in patients with shoulder pain compared with the frequency in the general population. Inconsistencies in the literature concerning anatomy, development, and frequency prompted the current anatomical study. The purpose of this study was to better define the frequency and anatomy of os acromiale in the general population. METHODS: Two thousand three hundred and sixty-seven scapular bones from 1198 human skeletons from the Hamann-Todd Osteological Collection were studied for evidence of os acromiale. The sample consisted of specimens from 1033 men and 165 women, 843 of whom had been white and 355, black. The mean age of the individuals at the time of death was 44.7 years (range, eighteen to eighty-nine years). The frequency of os acromiale was noted, and the specimens were measured. RESULTS: There were 128 cases of os acromiale in ninety-six (8.0 percent) of the 1198 skeletons, and the condition was bilateral in thirty-two (33.3 percent) of the ninety-six skeletons. In twenty cases, the free fragment had been lost but it was assumed that a fragment had been present because the acromion was truncated. Os acromiale was more frequent in blacks than in whites (13.2 compared with 5.8 percent; p < 0.001) and in men than in women (8.5 compared with 4.9 percent; p = 0.09). The mean proportional length of the free fragment was 0.42 compared with the overall length of the acromion. Care was taken to differentiate os acromiale from a normal immature acromion. Six skeletons demonstrated persistent acromial apophyses. All six cases were bilateral; seven fragments were fusing, and five were free. The oldest age at which a persistent normal apophysis was found was twenty-one years. The frequency of os acromiale in specimens from individuals who had been less than twenty-two years old was not significantly different from that in the remainder of the collection (p = 0.74). Twenty-one scapulae had a distinct circumferential line that was suggestive of an acromial joint, but the distal and proximal portions were solidly fused. However, the findings on plain axillary radiographs of sixteen of these specimens were indistinguishable from those of specimens with os acromiale. CONCLUSIONS: An anatomical study, performed to better define the frequency and anatomy of os acromiale in the general population, showed that fused os acromiale, which has not been described previously, might be mistaken for a free ossicle in the clinical setting.

Acromion↗
PubMed2006

Is there a safe area for the axillary nerve in the deltoid muscle? A cadaveric study.

BACKGROUND: Several authors have defined a variety of so-called safe zones for deltoid-splitting incisions. The first aim of the present study was to investigate the distance of the axillary nerve from the acromion and its relation to arm length. The second aim was to identify a safe area for the axillary nerve during surgical dissection of the deltoid muscle. METHODS: Twenty-four shoulders of embalmed adult cadavers were included in the study. The distance from the anterior edge of the acromion to the course of the axillary nerve was measured and was recorded as the anterior distance. The same measurement from the posterior edge of the acromion to the course of the axillary nerve was made and was recorded as the posterior distance for each limb. Correlation analysis was performed between the arm length and the anterior distance and the posterior distance for each limb. The ratios between arm length and the anterior and posterior distances were calculated for each case and were recorded as an anterior index and a posterior index. RESULTS: The average arm length was 30.40 cm. The average anterior distance was 6.08 cm, and the average posterior distance was 4.87 cm. There was a significant correlation between arm length and both anterior distance (r = 0.79, p < 0.001) and posterior distance (r = 0.61, p = 0.001). The axillary nerve was not found to lie at a constant distance from the acromion at every point along its course. The average anterior index was 0.20, and the average posterior index was 0.16. CONCLUSIONS: The present study describes a safe area above the axillary nerve that is quadrangular in shape, with the length of the lateral edges being dependent on the individual's arm length. Using this safe area should provide a safe exposure for the axillary nerve during shoulder operations.

Acromion↗
PubMed1994

Categorization of acromial shape: interobserver variability with MR imaging and conventional radiography.

OBJECTIVE: Our purpose was to determine interobserver variability in the interpretation of the shape of the acromion on sagittal oblique MR images and conventional radiographs. The shape of the acromion was defined according to a previously described classification scheme. MATERIALS AND METHODS: We reviewed 26 sets of sagittal oblique MR images and corresponding conventional Y- or outlet-view radiographs of the shoulder. The shape of the acromion was graded for each study independently by four reviewers. Interobserver agreement was measured by using the kappa statistic. Analysis of variance and the chi 2-test were used for univariate analysis. RESULTS: The acromion was interpreted most often as being curved. The observers scored 9% of MR images and 28% of conventional radiographs as nondiagnostic (p < .001) (41% of transscapular Y views and 3% of supraspinatus outlet views were also considered nondiagnostic [p < .0001]). Kappa values were .23 for MR images and .43 for conventional radiographs. Variability in interpretation between techniques when controlled for observer was not statistically significant. CONCLUSION: Although sagittal oblique MR images were significantly more likely than conventional radiographs to be considered diagnostic by observers, interobserver agreement for MR examinations was poor. There was moderate agreement with conventional radiographs. This calls into question the usefulness of the previous system of interpretation and suggests that it might be more applicable with conventional radiographs than with MR images.

Acromion↗
PubMed2003

Correlation of age, acromial morphology, and rotator cuff tear pathology diagnosed by ultrasound in asymptomatic patients.

The importance of acromial morphology in the pathogenesis of rotator cuff tears remains controversial. Some surgeons place great emphasis on acromial morphology and others feel that acromial shape is a result of cuff tear pathology rather than the cause. The purpose of this study was to determine if there was an association between acromial morphology, age, and rotator cuff tears found by ultrasound in asymptomatic volunteer subjects with no past history of shoulder symptoms. One hundred eighteen outlet x-rays and ultrasound scans were performed in 59 asymptomatic patients in various age groups. Acromial morphology and the age of the patients were then correlated with the ultrasound findings. Older patients were noted to have a high incidence of type II and type III acromions (93% of those over 70). Full- and partial-thickness tears were more commonly seen in patients with type II or type III acromions compared with type I. Patients over 50 years had a high incidence of full-thickness tears (40%), but the incidence did not increase with increasing age past 50. These findings lend credence to the multifactorial etiology of rotator cuff tears. The patient's age (degeneration) and acromial morphology (impingement) are two of the factors involved in causing rotator cuff tears. The incidence of cuff tears and type III acromions was high in this group of entirely asymptomatic volunteer subjects. Surgeons should interpret radiologically hooked or curved acromions as well as rotator cuff tears diagnosed with ultrasound or other modalities with caution. It may well be that both of these findings should be regarded as part of the natural ageing process.

Acromion↗