Summary
A reduction of the subacromial space and an increased subacromial pressure have been considered to play an important role in the pathogenesis of rotator cuff lesions. The objective of the current study was to develop a CT based method for measuring the acromiohumeral distance and inferior acromial mineralization. In seven patients with unilateral rupture of the rotator cuff and two with impingement syndrome, transverse CT images were obtained at a section thickness of 1 mm with muscular relaxation in a standardized position. The bones were then reconstructed three-dimensionally, and the minimal vertical distance between the acromion and the humerus was determined in three secondary frontal images on both sides. The distribution of mineralization within the inferior surface of the acromion was assessed using CT osteoabsorptiometry. Although the Constant score was significantly reduced in the diseased shoulders, the width of the subacromial space was not routinely lower than on the contralateral side. In seven cases the maximal inferior acromial mineralization was identical in both shoulders, and in two cases it was lower on the affected side. These preliminary data suggest that with muscular relaxation no narrowing of the subacromial space can be detected in secondary frontal CT images, and that a potential increase of subacromial pressure is not high enough to cause a measurable increase in inferior acromial bone density. The method presented makes it possible to investigate the pathogenesis of the supraspinatus outlet syndromein vivo with greater precision than has so far been possible with conventional radiography.
Résumé
Une réduction de l'espace sous-acromial et une augmentation de la pression sous-acromiale avait été considérées comme jouant un rôle très important dans la pathogénie des lésions de la coiffe des rotateurs. L'objectif de cette étude est de développer une méthode basée sur la tomodensitométrie, pour mesurer la distance acromio-humérale et la minéralisation de la partie inférieure de l'acromion. Chez 7 patients avec une rupture unilatérale de la coiffe des rotateurs et deux avec un syndrome de conflit, des images acquises en coupes axiales transverses étaient obtenues avec une section d'épaisseur de 1 mm en situation de relaxation musculaire dans une position standard. Les structures osseuses étaient ensuite reconstruites en trois dimensions, la distance minimale verticale entre l'acromion et l'humérus était déterminée sur trois images frontales des deux côtés. La distribution de la minéralisation à l'intérieur de la surface caudale de l'acromion était évaluée en utilisant une méthode d'ostéo-absorptiométrie. Bien que le score de Constant était significantivement réduit chez les épaules malades, l'épaisseur de l'espace sous-acromial n'était pas systématiquement plus bas que du côté controlatéral. Dans 7 cas, les zones de minéralisation maximale de l'acromion étaient identiques dans les deux épaules et dans 2 cas étaient plus basses du côté affecté. Cette étude préliminaire suggère qu'avec la relaxation musculaire, un amincissement de l'espace sous-acromial ne peut pas être détecté sur des images de reconstruction frontale, par tomodensitométrie tridimensionnelle et qu'un potentiel d'accroissement de la pression subacromiale n'est pas assez élevé pour causer une augmentation de la densité osseuse de l'acromion. La méthode présentée rend possible l'investigation de la pathogénie du défilé du m. supraépineuxin vivo avec une plus grande précision que ce qui a été possible jusqu'alors avec la radiographie conventionnelle.
Similar content being viewed by others
References
Anetzberger H, Putz R (1995) Die Morphometrie des subakromialen Raumes und ihre klinische Relevanz. Unfallchirurg 98: 407–414
Anetzberger H, Putz R (1996) The scapula: Principles of construction and stress. Acta Anat 156: 70–80
Aoki M, Ishii S, Usui M (1986) The slope of the acromion and rotator cuff impingement. Orthop Trans 10: 228
Bigliani LU, Ticker JB, Flatow EL, Soslowsky LJ, Mow VC (1991) The relationship of acromial architecture to rotator cuff disease. Clin Sports Med 10: 823–838
Brewer BJ (1979) Aging of the rotator cuff. Am J Sports Med 7: 102–110
Codman EA (1934) The shoulder. Thomas Todd, Boston
Constant CR (1991) Schulterfunktionsbeurteilung. Orthopäde 20: 289–294
Cotton RE, Rideout DF (1964) Tears of the humeral rotator cuff. J Bone Joint Surg [Br] 46-B: 314–328
Eckstein F, Putz R, Müller-Gerbl M, Steinlechner M, Benedetto KP (1993) Cartilage degeneration in the human patella and its relationship to the mineralisation of the underlying bone: A key to the understanding of chondromalacia patellae and femoropatellar arthrosis? Surg Radiol Anat 15: 279–286
Eckstein F, Löhe M, Steinlechner M, Müller-Gerbl M, Putz R (1994b) Stress distribution in the trochlear notch as a model of bicentric load transmission through joints. J Bone Joint Surg [Br] 76-B: 647–653
Eckstein F, Müller-Gerbl M, Steinlechner M, Kierse R, Putz R (1995) Subchondral bone density of the human elbow assessed by CT osteoabsorptiometry: a reflection of the loading history of the joint surfaces. J Orthop Res 13: 268–278
Eckstein F, Merz B, Müller-Gerbl M, Holzknecht N, Pleier M, Putz R (1995) Morphomechanics of the humero-ulnar joint: II. Concave incongruity determines the distribution of load and subchondral mineralization. Anat Rec 243: 327–335
Edelson JG, Taitz C (1992) Anatomy of the coracoacromial arch. Relation to degeneration of the acromion. J Bone Joint Surg [Br] 74-B: 589–594
Edelson JG, Taitz C (1993) Bony anatomy of coracoacromial arch: Implications for arthroscopic portal placement in the shoulder. Arthroscopy 9: 201–208
Epstein RE, Schweitzer ME, Frieman BG, Fenlin JM Jr, Mitchell DG (1993) Hooked acromion: prevalence on MR images of painful shoulders. Radiology 187: 479–481
Farley TE, Neumann CH, Steinbach LS, Petersen SA (1994) The coracoacromial arch: MR evaluation and correlation with rotator cuff pathology. Skeletal Radiol 23: 641–645
Fukuda H, Hamada K, Yamanaka K (1990) Pathology and pathogenesis of bursal-side rotator cuff tears viewed from en bloc histologic sections. Clin Orthop Rel Res 254: 75–80
Gagey N, Ravaud E, Lassau JP (1993) Anatomy of the acromial arch: correlation of anatomy and magnetic resonance imaging. Surg Radiol Anat 15: 63–70
Golding FC (1962) The shoulder-the forgotten joint. Br J Radiol 35: 149–158
Habermeyer P (1989) Sehnenrupturen im Schulterbereich. Orthopäde 18: 257–267
Harrison L, McLaughlin (1962) Rupture of the rotator cuff. J Bone Joint Surg [Am] 44-A: 979–983
Hawkins RJ, Misamore GW, Hobeika PE (1985) Surgery for full-thickness rotator-cuff tears. J Bone Joint Surg [Am] pp 1349–1355
Haygood TM, Langlotz CP, Kneeland JB, Iannotti JP, Williams GR Jr, Dalinka MK (1994) Categorization of acromial shape: interobserver variability with MR imaging and conventional radiography. AJR 162: 1377–1382
Keyes EL (1935) Anatomical observations on senile changes in the shoulder. J Bone Joint Surg 17: 953–960
Lohr JF, Uhthoff HK (1989) The microvascular pattern of the supraspinatus tendon. Clin Orthop Rel Res 254: 35–38
Macnab J (1981) Die pathologische Grundlage der sogenannten Rotatorenmanschetten-Tendinitis. Orthopäde 10: 191–195
Matsen FA, Fu FH, Hawkins RJ (1993) The shoulder: A balance of mobility and stability. Workshop Vail Colerado, 1992, American Academy of Orthopaedic Surgeons Symposium, Rosemont, pp 239–251
Moseley HF, Goldie I (1963) The arterial pattern of the rotator cuff of the shoulder. J Bone Joint Surg [Br] 45-B: 780–789
Müller-Gerbl M, Putz R, Hodapp N, Schulte E, Wimmer B (1989) Computed tomography-osteoabsorptiometry for assessing the density distribution of subchondral bone as a measure of long term mechanical adaptation in individual joints. Skeletal Radiol 18: 507–512
Müller-Gerbl M, Putz R, Hodapp N, Schulte E, Wimmer B (1990) Computed tomography-osteoabsorptiometry: A method of assessing the mechanical condition of the major joints in a living subject. Clin Biomech 5: 193–198
Müller-Gerbl M, Putz R, Kenn R (1992) Demonstration of subchondral bone density patterns by three dimensional CT osteoabsorptiometry as a noninvasive method for in vivo assessment of individual long-term stresses in joints. J Bone Min Res 7 [Suppl 2]: 411–418
Müller-Gerbl M, Putz R, Kenn R, Kierse R (1993) People in different age groups show different hip joint morphology. Clin Biomech 8: 66–72
Müller-Gerbl M, Griebl R, Putz R, Goldmann A, Kuhr M, Taeger KH (1994) Assessment of subchondral bone density distribution patterns in patients subjected to correction osteotomy. Trans Orthop Res Soc 19: 574
Müller-Gerbl M, Maier U, Anetzberger H, Pleier M, Putz R (1997) Quantitative determination of the 3D changes in the subarticular mineralization of the tibia following correction osteotomy. Trans Orthop Res Soc 22: 646
Neer CS (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder. A preliminary report. J Bone Joint Surg [Am] 54-A: 41–50
Neer CS (1983) Impingement lesions. Clin Orthop Rel Res 173: 70–81
Nirschl RP (1989) Rotator cuff tendinitis: Basic concepts of pathoetiology. In: Barr JS (ed) Instructional course letters. Am Assoc Orthop Surg 28: 439–445
Ozaki J, Fujimoto S, Nakagawa Y, Masuhara K, Tamai S (1988) Tears of the rotator cuff of the shoulder associated with pathological changes in the acromion. J Bone Joint Surg [Am] 8-A: 1224–1230
Peh WC, Farmer TH, Totty WG (1995) Acromial arch shape: Assessment with MR imaging. Radiology 195: 501–505
Petersson CJ, Redlund-Johnell I (1984) The subacromial space in normal shoulder radiographs. Acta Orthop Scand 55: 57–58
Putz R, Liebermann J, Reichelt A (1988) Funktion des Ligamentum coracoacromiale. Acta Anat 131: 140–145
Rathbun JB, Macnab I (1970) The microvascular pattern of the rotator cuff. J Bone Joint Surg [Br] 52-B: 540–555
Rockwood CA (1980) The role of anterior impingement to lesions of the rotator cuff. J Bone Joint Surg [Br] 62-B: 274–279
Sperner G (1995) Die Bedeutung des Subakromialraums für die Entstehung des Impingementsyndroms. Unfallchirurg 98: 309–319
Sumanaweera T, Glover G, Song S, Adler J, Napel S (1994) Quantifying MRI geometric distortion in tissue. Magn Reson Med 31: 40–47
Tichy P, Tillmann B, Schleicher A (1985) Funktionelle Beanspruchung des Fornix humeri. In: Refior HJ, Plitz W, Jäger M, Hackenbroch MH (eds) Biomechanik der gesunden und kranken Schulter. Thieme, Stuttgart New York
Wasmer G, Hagenda FW, Bergmann M, Mittlmeier T (1985) Anatomische und biomechanische Untersuchungen des Ligamentum coracoacromiale am Menschen. In: Refior HJ, Plitz W, Jäger M, Hackenbroch MH (eds) Biomechanik der gesunden und kranken Schulter. Thieme, Stuttgart New York
Weiner DS, Mcnab J (1970) Superior migration of the humeral head. A radiological aid in the diagnosis of tears of the rotator cuff. J Bone Joint Surg 52: 524–527
Wuelker N, Melzer C, Wirth CJ (1991) Shoulder surgery for rotator cuff tears. Ultrasonographic 3-year follow-up of 97 cases. Acta Orthop Scand 62: 142
Wuelker N, Plitz W, Roetman B (1994) Biomechanical data concerning the shoulder impingement syndrome. Clin Orthop 303: 242–249
Zuckerman JD, Cuomo F, Kummer FJ (1991) The influence of coracoacromial arch anatomy on rotator cuff tears. J Shoulder Elbow Soc 1: 4–13
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lochmüller, E.M., Maier, U., Anetzberger, H. et al. Determination of subacromial space width and inferior acromial mineralization by 3D CT. Surg Radiol Anat 19, 329–337 (1997). https://doi.org/10.1007/BF01637604
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01637604