Proceeding Introduction Objective Result

Srinagarind Med J 2012: 27 (Suppl)

Association between Acromiohumeral Distance and MRI Finding in Rotator Cuff Tear Tosapol Nuttaranga, Manusak Boonard Department of Orthopaedic, Faculty of Medicine, Khon Kaen University

Introduction

Rotator cuff tear A disease that causes abnormalities of the shoulder. The incidence of this disease is quite varied from 5% to 39%. Cause of rotator cuff tear is traumatic or degenerative. Moreover, the symptoms of this disease are varied such as shoulder pain, muscle weakness around the shoulder, loss of function of the involve arm, or maybe asymptomatic2-3. The physical examination and the x-ray are unable to get the definite diaagnosis. Magnetic resonance imaging (MRI) is the gold standard for diagnosis of rotator cuff tear. However, MRI has a very high cost and unavailable for the small hospital. Several studies have showed that superior migration of humeral head have been fiund in rotator cuff tear patients4-6. In 1970 Weiner, et al7 had proposed Acromiohumeral distance (AHD) in the plain x-ray shoulder AP view. If the AHD is less than 7 mm. suggest that rotator cuff tear. But in this study, it did not have specific location it measurement. So, the reliability is low. In 2005 Nadja Saupe8 had proposed the technique for measure acromiohumeral distance.

Figure 2 Measurement of AHD by Werner technique. Set The line drawn through the inferior side of Acromian process and draw a line parallel the first line and pass through humeral head. Then measure the distance between two lines. The purpose of this study is to study the relationship of Acromiohumeral distance and Rotator cuff tear in Thai patients and compare the two types of measurement reliability.

Objective

1. To determine the relationship of Acromiohumeral distance to diagnose Rotator cuff tear. 2. To comparative the measurements of Acromiohumeral distance in the two technique. 3. To study the Interobserver Reliability in the two technique.

Result

Figure 1 Measurement of AHD by Nadja technique. Set the point that is the most Sclerosis of both Acromian and Humeral head, Then measure the distance between two points. In 2008 Werner9 had proposed the technique for measuring Acromiohumeral distance.

Mean age (Range) Gender Male Famale Side Right Left

Rotator cuff tear 48.16 (34-56)

Not tear 28.35 (17-43)

5 1

6 2

1 5

6 2

การประชุมวิชาการ ครั้งที่ 28 ประจ�ำปี 2555

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Proceeding

Table 1 Demographic data of the patients

Srinagarind Med J 2012: 27 (Suppl) A comparative study of the relationship between the AHD and MRI finding were not significantly different of Clement and Nadja technique (Table 2) Table 2 Relationship between AHD and MRI finding Observer 1

Method Clement

MRI finding Rotator cuff tear Not tear Rotator cuff tear Not tear Rotator cuff tear Not tear Rotator cuff tear Not tear

Nadja 2

Clement Nadja

n 5 10 5 10 5 10 5 10

Mean 9.21 9.40 9.26 10.21 9.18 9.29 8.75 8.16

SD 3.64 2.44 4.15 2.41 3.61 2.25 3.53 2.05

P value 0.906 0.581 0.942 0.685

Table 3 Comparison between the two models. Observer 1

Method Clement Nadja Clement Nadja

2

Comparison of methods for measuring the AHD between Clement and Nadja techniques. it was found that the two methods are significantly different as table 3

Discussion

Acromiohumeral distance did not correlate with Rotator cuff tear and the difference between 2 technique is high. The accuracy of the measurements is poor. May be due to the measurement point is difficult in practice, Such as Nadja technique if unable to identify sclerotic rim of acromian process, it will be unable to determine the superior side. And in Clement Technique, if it has hook of acromian process, it will be difficult to draw the line. However, the number of patients in the study Rotator cuff tear is a small, it may need to be studied further in the future.

Proceeding

Reference

1. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. J Shoulder Elbow Surg. Prevalence and risk factors of a rotator cuff tear in the general population. 2010; 19:116-20. 2. Cotton RE, Rideout DF. Tears of the humeral rotator cuff; radiological and pathological necropsy survey. J Bone Joint Surg Br 1964; 46:314-28.

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การประชุมวิชาการ ครั้งที่ 28 ประจ�ำปี 2555

Mean 9.34 9.89 9.25 8.36

SD 2.76 2.98 2.64 2.53

P-value 0.025 0.002

3. Huang LF, Rubin DA, Britton CA. Greater tuberosity changes as revealed by radiography: lack of clinical usefulness in patients with rotator cuff disease. AJR Am J Roentgenol 1999; 1172:1381-8. 4. Van de Sande MAJ, Rozing PM. Proximal migration can be measured accurately on standardized anteroposterior shoulder radiographs. Clin Orthop Relat Res 2006; 443:260–5. 5. Nové-Josserand L, Levigne C, Noel E, Walch G. The acromio-humeral interval: a study of the factors influencing its height [in French]. Rev Chir Orthop Reparatrice Appar Mot 1996; 82:379–85 6. Sharkey NA, Marder RA. The rotator cuff opposes superior translation of the humeral head. Am J Sports Med. 1995; 23:270-5. 7. Weiner DS, Macnab I. Superior migration of the humeral head. A radiological aid in the diagnosis of tears of the rotator cuff. J Bone Joint Surg Br 1970; 52:524-7. 8. Saupe N, Pfirrmann CW, Schmid MR, Jost B, Werner CM, Zanetti M. Association between rotator cuff abnormalities and reduced acromiohumeral distance. AJR Am J Roentgenol 2006; 187:376-82. 9. Werner CM, Conrad SJ, Meyer DC, Keller A, Hodler J, Gerber C. Intermethod agreement and interobserver correlation of radiologic acromiohumeral distancemeasurements. J Shoulder Elbow Surg 2008; 17:237-40.