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Rotator Cuff Disease Xray and Ultrasound Features

Rotator Cuff Disease: X-ray and ultrasound features Rotator cuff tears can affect each of the muscles making up the rotator cuff individually, or in combination Authors: Jared Topham Reviewers: Raafi Ali, Kelley DeSouza* * MD at time of publication Supraspinatus tear (most common) Chronic (>3 months) tear with degenerative-type changes Rotator cuff insufficiency, loss of supporting structures holding humeral head inferiorly Displacement of the humeral head anterosuperiorly and instability of joint Microtrauma affecting superior aspect of glenohumeral joint “Acetabularization” or coracoacromial arch: concave acromial erosion and increased sclerosis (hardening) Subscapularis tear (second most common) Teres minor tear Infraspinatus tear Rotator Cuff Syndrome (Inflammation, impingement, or tearing of one or more of the four muscles/tendons of the rotator cuff: supraspinatus, subscapularis, infraspinatus, teres minor) Acute (partial or full thickness) tear of rotator cuff tendons Humeral subluxation (partial displacement of humeral head relative to glenoid) High riding humerus: decreased acromial humeral distance Decreased acromial humeral interval/space (impinging tendons of rotator cuff) Full: Defect extends from the subacromial bursa (fluid filled sack beneath the acromion and above the rotator cuff tendons) to the articular surface of the glenohumeral joint Tendon/muscle fibers completely separated from bone and/or muscle fiber connections severed Partial: Focal defect affecting a portion of the tendon which may involve the bursa or glenohumeral articular surface Non-visualization of the tendon Acetabularization of glenoid Fluid replaces empty space of tendon tear Overlying fat around the sub acromial bursa falls into tendon gap Sagging peribursal fat sign on ultrasound “Femoralization” of the humerus: bone erosion (destruction) and rounding of greater tuberosity Osteoarthritis of glenohumeral joint: See Osteoarthritis (OA): X-ray features slide Hyperechoic (brightened) line between articular cartilage of humeral head and muscle tendon on ultrasound Cartilage interface sign on ultrasound Hypoechoic (darkened) tendon outline discontinuity on ultrasound imaging Femoralization (rounding) of greater tuberosity Subluxation of the humeral head relative to the glenoid Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published September 6, 2023 on www.thecalgaryguide.com