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Wu H, Zuo Z, Li Y, Song H, Hu W, Chen J, Xie C, Lin L. Anatomic characteristics of shoulder based on MRI accurately predict incomplete rotator cuff injuries in patients: relevance for predictive, preventive, and personalized healthcare strategies. EPMA J 2023; 14:553-570. [PMID: 37605646 PMCID: PMC10439871 DOI: 10.1007/s13167-023-00333-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/03/2023] [Indexed: 08/23/2023]
Abstract
Background and PPPM-related working hypothesis In the diagnosis of incomplete rotator cuff injuries (IRCI), magnetic resonance imaging (MRI) and ultrasound examination often have false-positive and false-negative results, while arthroscopy is expensive, invasive, and complex. From the strategy of predictive, preventive, and personalized medicine (PPPM), shoulder anatomical characteristics based on MRI have been demonstrated to accurately predict IRCI and their clinical applicability for personalized prediction of IRCI. Aims This study aimed to develop and validate a nomogram based on anatomical features of the shoulder on MRI to identify IRCI for PPPM healthcare strategies. Methods The medical information of 257 patients undergoing preoperative MRI examination was retrospectively reviewed and served as the primary cohort. Partial-thickness rotator cuff tears (RCTs) and tendinopathy observed under arthroscopy were considered IRCI. Using logistic regression analyses and least absolute shrinkage and selection operator (LASSO), IRCI was identified among various preoperative factors containing shoulder MRI and clinical features. A nomogram was constructed and subjected to internal and external validations (80 patients). Results The following eight independent risk factors for IRCI were identified:AgeThe left injured sidesThe Goutallier classification of supraspinatus in oblique coronal positionThe Goutallier classification of supraspinatus in the axial positionAcromial thicknessAcromiohumeral distanceCoracohumeral distanceAbnormal acromioclavicular joint signalsThe nomogram accurately predicted IRCI in the development (C-index, 0.932 (95% CI, 0.891, 0.973)) and validation (C-index, 0.955 (95% CI, 0.918, 0.992)) cohorts. The calibration curve was consistent between the predicted IRCI probability and the actual IRCI ratio of the nomogram. The decision curve analysis and clinical impact curves demonstrated that the model had high clinical applicability. Conclusions Eight independent factors that accurately predicted IRCI were determined using MRI anatomical findings. These personalized factors can prevent unnecessary diagnostic interventions (e.g., arthroscopy) and can assist surgeons in implementing individualized clinical decisions in medical practice, thus addressing the goals of PPPM. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-023-00333-5.
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Affiliation(s)
- Hangxing Wu
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Zhijie Zuo
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Yucong Li
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Haoqiang Song
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Wanyan Hu
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Jingle Chen
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Chao Xie
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Lijun Lin
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
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Li L, Dong J, Li Q, Dong J, Wang B, Zhou D, Liu F. MRA improves sensitivity than MRI for the articular-sided partial-thickness rotator cuff tears. Sci Prog 2021; 104:368504211059976. [PMID: 34939473 PMCID: PMC10364937 DOI: 10.1177/00368504211059976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aims to compare the diagnostic accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) for the articular-sided partial-thickness rotator cuff tear (PTRCT). METHODS Three electronic databases, PubMed/Medline, Embase and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting articular-sided PTRCTs. The pooled statistical indexes included sensitivity, specificity, positive/negative predictive value, diagnostic odds ratio (DOR) and the area under the receiver operating characteristic curve (AUC). RESULTS Eleven studies involving 1703 patients and 1704 shoulders were included. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRA to diagnose articular-sided PTRCTs were 0.81 (95% CI, 0.65-0.90), 0.96 (95% CI, 0.91-0.98), 68.14 (95% CI, 33.20-139.84) and 0.96 (95% CI, 0.94-0.97), respectively. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRI were 0.78 (95% CI, 0.65-0.87) and 0.97 (95% CI, 0.84-0.99), 47.82 (95% CI, 8.29-275.89) and 0.89 (95% CI, 0.86-0.92), respectively. CONCLUSIONS This meta-analysis reveals that MRA has a better diagnostic value than that of MRI for the diagnosis of articular-sided partial-thickness rotator cuff tears because of an improvement of sensitivity.
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Affiliation(s)
- Lianxin Li
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Qinghu Li
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jinye Dong
- Department of Ultrasound, Weifang People's Hospital, Weifang 261041, Shandong, PR China
| | - Bingzhi Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
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Liu F, Dong J, Shen WJ, Kang Q, Zhou D, Xiong F. Detecting Rotator Cuff Tears: A Network Meta-analysis of 144 Diagnostic Studies. Orthop J Sports Med 2020; 8:2325967119900356. [PMID: 32076627 PMCID: PMC7003181 DOI: 10.1177/2325967119900356] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many imaging techniques have been developed for the detection of rotator cuff tears (RCTs). Despite numerous quantitative diagnostic studies, their relative accuracy remains inconclusive. PURPOSE To determine which of 3 commonly used imaging modalities is optimal for the diagnosis of RCTs. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Studies evaluating the performance of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and ultrasound (US) used in the detection of RCTs were retrieved from the PubMed/MEDLINE and Embase databases. Diagnostic data were extracted from articles that met the inclusion/exclusion criteria. A network meta-analysis was performed using an arm-based model to pool the absolute sensitivity and specificity, relative sensitivity and specificity, and diagnostic odds ratio as well as the superiority index for ranking the probability of these techniques. RESULTS A total of 144 studies involving 14,059 patients (14,212 shoulders) were included in this network meta-analysis. For the detection of full-thickness (FT) tears, partial-thickness (PT) tears, or any tear, MRA had the highest sensitivity, specificity, and superiority index. For the detection of any tear, MRI had better performance than US (sensitivity: 0.84 vs 0.81, specificity: 0.86 vs 0.82, and superiority index: 0.98 vs 0.22, respectively). With regard to FT tears, MRI had a higher sensitivity and superiority index than US (0.91 vs 0.87 and 0.67 vs 0.28, respectively) and a similar specificity (0.88 vs 0.88, respectively). The results for PT tears were similar to the detection of FT tears. A sensitivity analysis was performed by removing studies involving only 1 arm for FT tears, PT tears, or any tear, and the results remained stable. CONCLUSION This network meta-analysis of diagnostic tests revealed that high-field MRA had the highest diagnostic value for detecting any tear, followed by low-field MRA, high-field MRI, high-frequency US, low-field MRI, and low-frequency US. These findings can help guide clinicians in deciding on the appropriate imaging modality.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Jinlei Dong
- Department of Orthopedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Wun-Jer Shen
- Po Cheng Orthopedic Institute, Kaohsiung, Taiwan
| | - Qinglin Kang
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Dongsheng Zhou
- Department of Orthopedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Fei Xiong
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- Fei Xiong, MD, Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Yishan Road 600, Xuhui District, Shanghai 200233, China ()
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Huang T, Liu J, Ma Y, Zhou D, Chen L, Liu F. Diagnostic accuracy of MRA and MRI for the bursal-sided partial-thickness rotator cuff tears: a meta-analysis. J Orthop Surg Res 2019; 14:436. [PMID: 31831029 PMCID: PMC6909503 DOI: 10.1186/s13018-019-1460-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 11/06/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Numerous quantitatively studies have focused on the diagnosis of bursal-sided partial-thickness rotator cuff tears (RCTs); however, the accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) remains inconclusive. This study was performed systematically to compare the diagnostic value of MRA and MRI for the bursal-sided partial-thickness RCTs. METHODS Three electronic databases, PubMed, Embase, and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting bursal-sided partial-thickness RCTs. After screening and diluting out the articles that met the inclusion criteria to be used for statistical analysis, the pooled evaluation indexes include sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curve (AUC). RESULTS Twelve studies involving 1740 patients and 1741 shoulders were identified. The pooled sensitivity, specificity, DOR, and AUC of MRA to diagnose bursal-sided partial-thickness RCTs were 0.77 (95% CI, 0.67-0.85), 0.98 (95% CI, 0.95-0.99), 73.01 (95% CI, 35.01-152.26), and 0.88 (95% CI, 0.85-0.91), respectively. The pooled sensitivity, specificity, DOR, and AUC of MRI were 0.77 (95% CI, 0.66-0.86) and 0.96 (95% CI, 0.81-0.99), and 37.12 (95% CI, 8.08-170.64) and 0.82 (95% CI, 0.78-0.85), respectively. CONCLUSIONS This meta-analysis reveals that MRA and MRI have similar diagnostic value for the diagnosis of bursal-sided partial-thickness rotator cuff tears.
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Affiliation(s)
- Tao Huang
- Department of Orthopaedics, Yantai Shan Hospital, Yantai, Shandong Province, China
| | - Jian Liu
- Department of Orthopaedics, Zhangqiu District People's Hospital of Jinan City, Zhangqiu District, Jinan City, Shandong Province, China
| | - Yupeng Ma
- Department of Orthopaedics, Yantai Shan Hospital, Yantai, Shandong Province, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Liang Chen
- Department of Orthopaedics, Shandong Provincial Western Hospital, No. 4, Road Duan Xing Xi, Jinan, 250022, Shandong, China.
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
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Okoroha KR, Mehran N, Duncan J, Washington T, Spiering T, Bey MJ, Van Holsbeeck M, Moutzouros V. Characterization of Rotator Cuff Tears: Ultrasound Versus Magnetic Resonance Imaging. Orthopedics 2017; 40:e124-e130. [PMID: 27755645 DOI: 10.3928/01477447-20161013-04] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/30/2016] [Indexed: 02/03/2023]
Abstract
Ultrasound and magnetic resonance imaging (MRI) are both capable of diagnosing full-thickness rotator cuff tears. However, it is unknown which imaging modality is more accurate and precise in evaluating the characteristics of full-thickness rotator cuff tears in a surgical population. This study reviewed 114 patients who underwent arthroscopic repair of a full-thickness rotator cuff tear over a 1-year period. Of these patients, 61 had both preoperative MRI and ultrasound for review. Three musculoskeletal radiologists evaluated each ultrasound and MRI in a randomized and blinded fashion on 2 separate occasions. Tear size, retraction status, muscle atrophy, and fatty infiltration were analyzed and compared between the 2 modalities. Ultrasound measurements were statistically smaller in both tear size (P=.001) and retraction status (P=.001) compared with MRI. The 2 image modalities showed comparable intraobserver reliability in assessment of tear size and retraction status. However, MRI showed greater interobserver reliability in assessment of tear size, retraction status, and atrophy. Independent observers are more likely to agree on measurements of the characteristics of rotator cuff tears when using MRI compared with ultrasound. As tear size increases, the 2 image modalities show greater differences in measurement of tear size and retraction status. Additionally, compared with MRI, ultrasound shows consistently low reliability in detecting subtle, but clinically important, degeneration of the soft tissue envelope. Although it is inexpensive and convenient, ultrasound may be best used to identify a tear, and MRI is superior for use in surgical planning for larger tears. [Orthopedics. 2017; 40(1):e124-e130.].
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Macías-Hernández SI, Morones-Alba JD, Miranda-Duarte A, Coronado-Zarco R, Soria-Bastida MDLA, Nava-Bringas T, Cruz-Medina E, Olascoaga-Gómez A, Tallabs-Almazan LV, Palencia C. Glenohumeral osteoarthritis: overview, therapy, and rehabilitation. Disabil Rehabil 2016; 39:1674-1682. [DOI: 10.1080/09638288.2016.1207206] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
| | | | | | - Roberto Coronado-Zarco
- Department of Orthopedic Rehabilitation, Instituto Nacional de Rehabilitación, México, D.F., Mexico
| | | | - Tania Nava-Bringas
- Department of Orthopedic Rehabilitation, Instituto Nacional de Rehabilitación, México, D.F., Mexico
| | - Eva Cruz-Medina
- Department of Orthopedic Rehabilitation, Instituto Nacional de Rehabilitación, México, D.F., Mexico
| | - Andrea Olascoaga-Gómez
- Department of Orthopedic Rehabilitation, Instituto Nacional de Rehabilitación, México, D.F., Mexico
| | | | - Chanell Palencia
- Postgraduate Division, Instituto Nacional de Rehabilitación, México, D.F., Mexico
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El-Kouba G, Andreas Huber T, Freitas JRW, Steglich V, Ayzemberg H, Santos AM. COMPARISON OF COMPLEMENTARY EXAMS IN THE DIAGNOSIS OF ROTATOR CUFF INJURIES. Rev Bras Ortop 2015; 45:418-25. [PMID: 27022589 PMCID: PMC4799092 DOI: 10.1016/s2255-4971(15)30430-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to evaluate the accuracy of simple radiography, ultrasound and magnetic resonance imaging (MRI) in diagnosing rotator cuff injuries, comparing their findings with open or arthroscopic surgery findings. Methods: Protocols of the Shoulder and Elbow Surgery Service for patients undergoing surgical treatment for rotator cuff injuries diagnosed by means of radiography, ultrasound and/or MRI between 2002 and 2007 were evaluated. Based on the data gathered, we analyzed the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of these complementary examinations, compared with the findings during the surgical procedures. Results: This study included 147 patients with a mean age of 46.09 years. All the patients had undergone a radiography examination, 101 had undergone ultrasound examination and 72 had undergone MRI. We found sensitivity of 13.8%, specificity of 2.6% and accuracy of 30% with radiography; sensitivity of 57.6%, specificity of 29.6% and accuracy of 51.4% with ultrasound; and sensitivity of 86.6%, specificity of 22.2% and accuracy of 63.3% with MRI. Conclusion: Radiography was found to be a specific examination when the mirror sign was present. MRI and ultrasound were shown to be reliable methods with high accuracy for diagnosing rotator cuff injuries.
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Affiliation(s)
- Gabriel El-Kouba
- Preceptors of the Residence Service, Institute of Orthopedics and Traumatology (IOT), Joinville, SC
| | - Thomas Andreas Huber
- Preceptors of the Residence Service, Institute of Orthopedics and Traumatology (IOT), Joinville, SC
| | | | - Valdir Steglich
- Preceptors of the Residence Service, Institute of Orthopedics and Traumatology (IOT), Joinville, SC
| | - Henrique Ayzemberg
- Preceptors of the Residence Service, Institute of Orthopedics and Traumatology (IOT), Joinville, SC
| | - Adriano M Santos
- Preceptors of the Residence Service, Institute of Orthopedics and Traumatology (IOT), Joinville, SC
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Arthroscopic decompression at the suprascapular notch: a radiographic and anatomic roadmap. J Shoulder Elbow Surg 2015; 24:433-8. [PMID: 25308066 DOI: 10.1016/j.jse.2014.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/23/2014] [Accepted: 07/25/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopic decompression of the suprascapular nerve (SSN) at the suprascapular notch is a technically demanding procedure. Additional preoperative and intraoperative information may assist surgeons. The purpose of this study was to (1) identify which imaging modality most accurately represents the anatomic distance to the notch and (2) quantify the mean intraoperative distances from routine arthroscopic portals to the notch. METHODS Ten matched pairs of fresh cadaveric shoulders were imaged by roentgenogram, computed tomography (CT), magnetic resonance imaging, and 3-dimensional (3D) CT, followed by arthroscopic SSN decompression at the notch and anatomic dissection. Measurements obtained included the distances from the anterolateral, posterior, and SSN portal sites to the notch in addition to the distance from the anterolateral acromion to the notch. Statistical analysis with Spearman correlation coefficients and Bland-Altman plots were used to determine the correlation and agreement between measurements. RESULTS The preoperative imaging modality with the highest correlation to anatomic distances from the anterolateral acromion to the notch was 3D CT (Rs = 0.90, P < .0001). The mean intraoperative distances to the notch from the anterolateral, posterior, and SSN arthroscopic portals were 89 mm, 88 mm, and 49 mm, respectively. The mean anatomic distance from the anterolateral acromion to the notch was 64 mm. CONCLUSIONS Preoperative imaging with 3D CT may assist surgeons in performing arthroscopic SSN decompression. Understanding of the mean distances from the portal sites to the suprascapular notch and being cautious of arthroscopic instruments placed beyond 9 cm from laterally based portals may result in safer intraoperative medial dissection.
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Fischer CA, Weber MA, Neubecker C, Bruckner T, Tanner M, Zeifang F. Ultrasound vs. MRI in the assessment of rotator cuff structure prior to shoulder arthroplasty. J Orthop 2015; 12:23-30. [PMID: 25829757 DOI: 10.1016/j.jor.2015.01.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/04/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS We compared the accuracy of US to 3 T Tesla MRI for the detection of rotator cuff and long biceps tendon pathologies before joint replacement. METHODS 45 patients were prospectively included. RESULTS For the supraspinatus tendon, the accuracy of US when using MRI as reference was 91.1%. For the infraspinatus tendon, the accuracy with MRI as reference was 84.4%. The subscapularis tendon was consistently assessed by US and MRI in 35/45 patients (accuracy 77.8%). For the long biceps tendon the accuracy was 86.7%. CONCLUSION US detection of rotator cuff and biceps tendon integrity is comparable to MRI and should be preferred in revision cases.
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Affiliation(s)
- Christian Alexander Fischer
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, BW, 69118, Germany
| | - Marc-André Weber
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, BW, 69120, Germany
| | - Clément Neubecker
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, BW, 69118, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, BW, 69120, Germany
| | - Michael Tanner
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, BW, 69118, Germany
| | - Felix Zeifang
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, BW, 69118, Germany
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Chen DY, Haw-Chang Lan H, Lai KL, Chen HH, Chen YM, Chen CP. Diagnostic Utility of US for Detecting Rotator Cuff Tears in Rheumatoid Arthritis Patients: Comparison with Magnetic Resonance Imaging. J Med Ultrasound 2014. [DOI: 10.1016/j.jmu.2014.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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McMahon PJ, Prasad A, Francis KA. What is the prevalence of senior-athlete rotator cuff injuries and are they associated with pain and dysfunction? Clin Orthop Relat Res 2014; 472:2427-32. [PMID: 24619795 PMCID: PMC4079892 DOI: 10.1007/s11999-014-3560-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Older individuals with rotator cuff injuries may have difficulties not only with activities of daily living, but also with sports activities. QUESTIONS/PURPOSES (1) How frequent and severe are rotator cuff abnormalities, as identified by ultrasound, in senior athletes? (2) To what degree does the severity of ultrasound-identified rotator cuff pathology correlate with pain and shoulder dysfunction? METHODS We assessed pain and shoulder function in 141 elite athletes older than 60 years of age (median age, 70 years; range 60-84) at the Senior Olympics who volunteered to participate. An ultrasound evaluation of the rotator cuff of the dominant shoulder was performed by an experienced musculoskeletal radiologist in all of these elite athletes. We then determined the relationship between ultrasound findings and shoulder pain and shoulder function as assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) and American Shoulder and Elbow Surgeons (ASES) scores. RESULTS There were 20 shoulders with a normal cuff (14.2% [20 of 141], of which 5% [one of 20] were painful), 23 with tendinosis (16.3% [23 of 141], of which 30% [six of 20] were painful), 68 with a partial-thickness rotator cuff tear (48.2% [68 of 141], of which 32% [20 of 63] were painful), and 30 with a full-thickness rotator cuff tear (21.3% [30 of 141], of which 25% [seven of 28] were painful). Only 5% of athletes (one of 20) with a normal cuff on ultrasound evaluation reported shoulder pain, whereas 30% of athletes (33 of 111) with any degree of rotator cuff damage on ultrasound evaluation reported shoulder pain, This resulted in an odds ratio of 8.0 (95% confidence interval, 1.0-62.5). The proportion of patients who had pain was not different in those with different severities of rotator cuff pathology. Neither the ASES nor the DASH was different in those with different severities. CONCLUSIONS The frequency of full-thickness rotator cuff tears in senior athletes was 21.3% (30 of 141). Pain was a predictor of rotator cuff injury but not of its severity. The odds of having shoulder pain was eight times greater in those athletes with any rotator cuff damage as compared with those without any rotator cuff damage. Those with pain had poorer shoulder function but the ASES and DASH were poor predictors of the severity of rotator cuff pathology. Rotator cuff tears in older individuals are often not painful and may not need to be repaired for successful participation in athletics. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Patrick J. McMahon
- />McMahon Orthopedics & Rehabilitation, 2100 Jane Street, Pittsburgh, PA 15203 USA , />Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA USA
| | - Amitesh Prasad
- />Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
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Doğun A, Karabay İ, Hatipoğlu C, Özgirgin N. Ultrasound and magnetic resonance findings and correlation in hemiplegic patients with shoulder pain. Top Stroke Rehabil 2014; 21 Suppl 1:S1-7. [PMID: 24722039 DOI: 10.1310/tsr21s1-s1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the ultrasonography (US) and MRI findings in hemiplegic patients with shoulder pain and investigate the correlation between them. It is not possible for these patients to fully perform active range of motion (ROM) and stress tests, so imaging methods take center stage in diagnosis and treatment planning. MATERIALS AND METHODS A total of 68 hemiplegic patients with shoulder pain attending the inpatient rehabilitation program were included in the study. MRI and US results from the patient files were recorded. The frequency of each pathology identified by US and MRI was determined. The distribution of MRI and US findings was investigated to see whether there was a statistical difference between the correlation of MRI and US results. RESULTS The mean (SD) age of the patients was 63.7 (8.3) years and the mean (SD) duration of hemiplegia was 49 (8.9) days. According to the MRI results, glenohumeral and acromioclavicular joint degeneration was found in 77.9% and 79.7% of the patients, respectively; subacromial-subdeltoid bursitis in 80.9%; fluid increase in the joint space in 41.2%; supraspinatus tendinitis in 36.8%; and supraspinatus partial rupture in 33.8%. Shoulder US findings were supraspinatus tendinitis in 54.4%, acromioclavicular joint degeneration in 26.5%, bicipital tendinitis in 20.6%, and subacromial-subdeltoid bursitis in 19.1%. There was a statistically significant difference between MRI and US findings. The results were not compatible with each other (P ≯ .05), and these findings were not consistent with each other since the kappa coefficient was under 0.40 for all these results. CONCLUSION Although US is recommended as the first method in determining shoulder pathologies in hemiplegic patients, we suggest that MRI should be used as the first choice in hemiplegic patients with shoulder pain. MRI and US findings were not consistent, and US is dependent on the experience of the operator. MRI should be the first choice in cases where the diagnosis will affect the treatment choice due to the lack of correlation between US and MRI findings.
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Affiliation(s)
- Asuman Doğun
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - İlkay Karabay
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Cem Hatipoğlu
- Department of Radiology, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Neşe Özgirgin
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
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Abd-ElGawad EA, Ibraheem MA, Fouly EH. Evaluation of supraspinatus muscle tears by ultrasonography and magnetic resonance imaging in comparison with surgical findings. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NCA, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev 2013; 2013:CD009020. [PMID: 24065456 PMCID: PMC6464715 DOI: 10.1002/14651858.cd009020.pub2] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Shoulder pain is a very common symptom. Disorders of the rotator cuff tendons due to wear or tear are among the most common causes of shoulder pain and disability. Magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA) and ultrasound (US) are increasingly being used to assess the presence and size of rotator cuff tears to assist in planning surgical treatment. It is not known whether one imaging method is superior to any of the others. OBJECTIVES To compare the diagnostic test accuracy of MRI, MRA and US for detecting any rotator cuff tears (i.e. partial or full thickness) in people with suspected rotator cuff tears for whom surgery is being considered. SEARCH METHODS We searched the Cochrane Register of Diagnostic Test Accuracy Studies, MEDLINE, EMBASE, and LILACS from inception to February 2011. We also searched trial registers, conference proceedings and reference lists of articles to identify additional studies. No language or publication restrictions were applied. SELECTION CRITERIA We included all prospective diagnostic accuracy studies that assessed MRI, MRA or US against arthroscopy or open surgery as the reference standard, in people suspected of having a partial or full thickness rotator cuff tear. We excluded studies that selected a healthy control group, or participants who had been previously diagnosed with other specific causes of shoulder pain such as osteoarthritis or rheumatoid arthritis. Studies with an excessively long period (a year or longer) between the index and reference tests were also excluded. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data on study characteristics and results of included studies, and performed quality assessment according to QUADAS criteria. Our unit of analysis was the shoulder. For each test, estimates of sensitivity and specificity from each study were plotted in ROC space and forest plots were constructed for visual examination of variation in test accuracy. Meta-analyses were performed using the bivariate model to produce summary estimates of sensitivity and specificity. We were unable to formally investigate potential sources of heterogeneity because of the small number of studies. MAIN RESULTS We included 20 studies of people with suspected rotator cuff tears (1147 shoulders), of which six evaluated MRI and US (252 shoulders), or MRA and US (127 shoulders) in the same people. Many studies had design flaws, with the potential for bias, thus limiting the reliability of their findings. Overall, the methodological quality of the studies was judged to be low or unclear. For each test, we observed considerable heterogeneity in study results, especially between studies that evaluated US for the detection of full thickness tears and studies that evaluated MRA for the detection of partial thickness tears. The criteria for a positive diagnostic test (index tests and reference standard) varied between studies.Meta-analyses were not possible for studies that assessed MRA for detection of any rotator cuff tears or partial thickness tears. We found no statistically significant differences in sensitivity or specificity between MRI and US for detecting any rotator cuff tears (P = 0.13), or for detecting partial thickness tears (P = 1.0). Similarly, for the comparison between MRI, MRA and US for detecting full thickness tears, there was no statistically significant difference in diagnostic performance (P = 0.7). For any rotator cuff tears, the summary sensitivity and specificity were 98% (95% CI 92% to 99%) and 79% (95% CI 68% to 87%) respectively for MRI (6 studies, 347 shoulders), and 91% (95% CI 83% to 95%) and 85% (95% CI 74% to 92%) respectively for US (13 studies, 854 shoulders). For full thickness tears, the summary sensitivity and specificity were 94% (95% CI 85% to 98%) and 93% (95% CI 83% to 97%) respectively for MRI (7 studies, 368 shoulders); 94% (95% CI 80% to 98%) and 92% (95% CI 83% to 97%) respectively for MRA (3 studies, 183 shoulders); and 92% (95% CI 82% to 96%) and 93% (95% CI 81% to 97%) respectively for US (10 studies, 729 shoulders).Because few studies were direct head-to-head comparisons, we could not perform meta-analyses restricted to these studies. The test comparisons for each of the three classifications of the target condition were therefore based on indirect comparisons which may be prone to bias due to confounding. AUTHORS' CONCLUSIONS MRI, MRA and US have good diagnostic accuracy and any of these tests could equally be used for detection of full thickness tears in people with shoulder pain for whom surgery is being considered. The diagnostic performance of MRI and US may be similar for detection of any rotator cuff tears. However, both MRI and US may have poor sensitivity for detecting partial thickness tears, and the sensitivity of US may be much lower than that of MRI. The strength of evidence for all test comparisons is limited because most studies were small, heterogeneous and methodologically flawed, and there were few comparative studies. Well designed studies that directly compare MRI, MRA and US for detection of rotator cuff tears are needed.
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Affiliation(s)
- Mário Lenza
- Hospital Israelita Albert EinsteinOrthopaedic and Trauma DepartmentAv. Albert Einstein, 627/701São PauloSao PauloBrazilCEP 05651‐901
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Yemisi Takwoingi
- University of BirminghamPublic Health, Epidemiology and BiostatisticsEdgbastonBirminghamUKB15 2TT
| | - Renea V Johnston
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Nigel CA Hanchard
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughTees ValleyUKTS1 3BA
| | - Flávio Faloppa
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 783‐5th FloorSão PauloSão PauloBrazil
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Zhang S, Li H, Tao H, Li H, Cho S, Hua Y, Chen J, Chen S, Li Y. Delayed early passive motion is harmless to shoulder rotator cuff healing in a rabbit model. Am J Sports Med 2013; 41:1885-92. [PMID: 23845402 DOI: 10.1177/0363546513493251] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Postoperative passive motion is the most widely accepted rehabilitation protocol after rotator cuff repair; however, a rotator cuff retear remains a frequent surgical complication. Clinical outcomes indicate that early passive motion is harmless to rotator cuff healing, but no laboratory evidence supports this proposition. HYPOTHESES (1) Immediate postoperative immobilization improves rotator cuff healing in rabbits. (2) Early passive motion after short-term immobilization does not harm rotator cuff healing in rabbits. STUDY DESIGN Controlled laboratory study. METHODS An injury to the supraspinatus tendon was created and repaired in 90 New Zealand White rabbits, after which they were randomly separated into 3 groups: (1) nonimmobilization (NI; n = 30), (2) continuous immobilization (IM; n = 30), and (3) immobilization with early passive motion (IP; n = 30). At 3, 6, and 12 weeks postoperatively, 5 rabbits from each group were sacrificed for histological evaluation, biomechanical testing, and magnetic resonance imaging. RESULTS The histological study demonstrated better postoperative healing in the IM and IP groups, with clusters of chondrocytes accumulated at the tendon-bone junction. Magnetic resonance imaging illustrated that the tendon-bone junction was intact in the IM and IP groups. The magnetic resonance quantification analysis showed that the signal-to-noise quotient (SNQ) of the NI group was not significantly higher than that of the immobilization groups at 3 weeks (P = .232) or 6 weeks (P = .117), but it was significantly different at 12 weeks (NI vs IM, P = .006; NI vs IP, P = .009). At 12 weeks, the failure load was significantly higher in the IM and IP groups than in the NI group (NI vs IM, P = .002; NI vs IP, P = .002), but no difference was found between the IM and IP groups (P = .599). CONCLUSION Immediate postoperative immobilization led to better tendon-bone healing than immediate postoperative mobilization, and under immobilization, early passive motion was harmless to tendon-bone healing in this study. CLINICAL RELEVANCE The results have an implication in supporting the rehabilitation protocol of early passive motion after rotator cuff repair.
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Affiliation(s)
- Shurong Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, No. 12, Wulumuqi Zhong Road, Shanghai 200040, China
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Restrepo González R. Direct magnetic resonance arthrography, indirect magnetic resonance arthrography, and computed tomography arthrography for rotator cuff lesions and superior labral anterior and posterior tears: State of the art. RADIOLOGIA 2013. [DOI: 10.1016/j.rxeng.2012.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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17
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Ok JH, Kim YS, Kim JM, Yoo TW. Learning curve of office-based ultrasonography for rotator cuff tendons tears. Knee Surg Sports Traumatol Arthrosc 2013; 21:1593-7. [PMID: 22735978 DOI: 10.1007/s00167-012-2105-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 06/11/2012] [Indexed: 12/19/2022]
Abstract
PURPOSE To compare the accuracy of ultrasonography and MR arthrography (MRA) imaging in detecting of rotator cuff tears with arthroscopic finding used as the reference standard. METHODS The ultrasonography and MRA findings of 51 shoulders that underwent the arthroscopic surgery were prospectively analysed. Two orthopaedic doctors independently performed ultrasonography and interpreted the findings at the office. The tear size measured at ultrasonography and MRA was compared with the size measured at surgery using Pearson correlation coefficients (r). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and false-positive rate were calculated for a diagnosis of partial-and full-thickness rotator cuff tears. The kappa coefficient was calculated to verify the inter-observer agreement. RESULTS The sensitivity of ultrasonography and MRA for detecting partial-thickness tears was 45.5 and 72.7 %, and that for full-thickness tears was 80.0 and 100 %, respectively. The accuracy of ultrasonograpy and MRA for detecting partial-thickness tears was 45.1 and 88.2 %, and that for full-thickness tears was 82.4 and 98 %, respectively. Tear size measured based on ultrasonography examination showed a poor correlation with the size measured at arthroscopic surgery (r = 0.21; p < 0.05). However, tear size estimated by MRA showed a strong correlation (r = 0.75; p < 0.05). The kappa coefficient was 0.47 between the two independent examiners. CONCLUSIONS The accuracy of office-based ultrasonography for beginner orthopaedic surgeons to detect full-thickness rotator cuff tears was comparable to that of MRA but was less accurate for detecting partial-thickness tears and torn size measurement. Inter-observer agreement on the interpretation was fair. These results highlight the importance of the correct technique and experience in operation of ultrasonography in shoulder joint. LEVEL OF EVIDENCE Diagnostic study, Level II.
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Affiliation(s)
- Ji-Hoon Ok
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea.
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Restrepo González R. Artroresonancia directa, indirecta y artrotomografía para lesiones del mango rotador y Slap. Estado actual. RADIOLOGIA 2013; 55:283-93. [DOI: 10.1016/j.rx.2012.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 09/04/2012] [Accepted: 09/18/2012] [Indexed: 01/02/2023]
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Shi LL, Freehill MT, Yannopoulos P, Warner JJP. Suprascapular nerve: is it important in cuff pathology? Adv Orthop 2012; 2012:516985. [PMID: 23193484 PMCID: PMC3501891 DOI: 10.1155/2012/516985] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 10/08/2012] [Indexed: 01/02/2023] Open
Abstract
Suprascapular nerve and rotator cuff function are intimately connected. The incidence of suprascapular neuropathy has been increasing due to improved understanding of the disease entity and detection methods. The nerve dysfunction often results from a traction injury or compression, and a common cause is increased tension on the nerve from retracted rotator cuff tears. Suprascapular neuropathy should be considered as a diagnosis if patients exhibit posterosuperior shoulder pain, atrophy or weakness of supraspinatus and infraspinatus without rotator cuff tear, or massive rotator cuff with retraction. Magnetic resonance imaging and electromyography studies are indicated to evaluate the rotator cuff and function of the nerve. Fluoroscopically guided injections to the suprascapular notch can also be considered as a diagnostic option. Nonoperative treatment of suprascapular neuropathy can be successful, but in the recent decade there is increasing evidence espousing the success of surgical treatment, in particular arthroscopic suprascapular nerve decompression. There is often reliable improvement in shoulder pain, but muscle atrophy recovery is less predictable. More clinical data are needed to determine the role of rotator cuff repair and nerve decompression in the same setting.
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Affiliation(s)
- Lewis L. Shi
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Hospitals, 5841 South Maryland Avenue, MC 3079, Chicago, IL 60637, USA
| | - Michael T. Freehill
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, P.O. Box 1070, Winston-Salem, NC 27157-1070, USA
| | - Paul Yannopoulos
- Division of Shoulder Surgery, Massachusetts General Hospital, Yawkey Center 3G, 55 Fruit Street, Boston, MA 02114, USA
| | - Jon J. P. Warner
- Division of Shoulder Surgery, Massachusetts General Hospital, Yawkey Center 3G, 55 Fruit Street, Boston, MA 02114, USA
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Omoumi P, Bafort AC, Dubuc JE, Malghem J, Vande Berg BC, Lecouvet FE. Evaluation of Rotator Cuff Tendon Tears: Comparison of Multidetector CT Arthrography and 1.5-T MR Arthrography. Radiology 2012; 264:812-22. [DOI: 10.1148/radiol.12112062] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Although historically considered a diagnosis of exclusion, suprascapular neuropathy may be more common than once believed, as more recent reports are describing the condition as a cause of substantial pain and weakness in patients with and without concomitant shoulder pathology. The etiology is traction or compression of the suprascapular nerve. This can result from a space-occupying lesion, such as a ganglion cyst, or a traction injury as a result of repetitive overhead activities. More recent studies have cited cases of traction injuries occurring with retraction of a large rotator cuff tear. Atrophy of the infraspinatus and/or supraspinatus rotator cuff muscles with resultant weakness in forward flexion and/or external rotation of the shoulder on physical examination may be demonstrated. Magnetic resonance imaging (MRI) is the preferred modality to assess atrophy of the rotator cuff muscles as well as assess potential causes of suprascapular nerve compression. Electromyography and nerve conduction velocity studies remain the gold standard for confirmation of the diagnosis of suprascapular neuropathy; however, nerve pain may occur even in the setting of a negative electromyography. Initial management is usually nonoperative, consisting of activity modification, physical therapy, and nonsteroidal anti-inflammatory drugs. Surgical intervention is considered for patients with nerve compression by an external source or for symptoms refractory to conservative measures. Decompression of the suprascapular nerve may be accomplished through an open approach, although arthroscopic surgical approaches have become more common in the past several years.
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Affiliation(s)
- Michael T Freehill
- Harvard Shoulder Service, Massachusetts General Hospital, Boston, MA 02114, USA.
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Smith TO, Daniell H, Geere JA, Toms AP, Hing CB. The diagnostic accuracy of MRI for the detection of partial- and full-thickness rotator cuff tears in adults. Magn Reson Imaging 2012; 30:336-46. [PMID: 22260933 DOI: 10.1016/j.mri.2011.12.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 10/11/2011] [Accepted: 12/04/2011] [Indexed: 01/20/2023]
Abstract
This study assessed the diagnostic test accuracy of magnetic resonance imaging (MRI) in the detection of partial- and full-thickness rotator cuff tears in the adult population. A systematic review was conducted of the following electronic databases: Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, AMED, ISI Web of Science, Current Controlled Trials, National Technical Information Service, the National Institute for Health Research Portfolio, the UK National Research Register Archive and WHO International Clinical Trials Registry Platform database and reference lists of articles. All studies assessing the sensitivity and/or specificity of MRI for adult patients with suspected rotator cuff tear where surgical procedures were the reference standard were included in the study. A meta-analysis was performed to calculate pooled sensitivity, specificity, likelihood and diagnostic odds ratio values, and summary receiver operating characteristic plots were constructed. Forty-four studies were included. These included 2751 shoulders in 2710 patients. For partial-thickness rotator cuff tears, the pooled sensitivity and specificity values were 0.80 [95% confidence interval (CI): 0.79-0.84] and 0.95 (95% CI: 0.94-0.97), respectively. For full-thickness tears, the sensitivity and specificity values were 0.91 (95% CI: 0.86-0.94) and 0.97 (95% CI: 0.96-0.98), respectively. While there was no substantial difference in diagnostic test accuracy between MRIs reviewed by general radiologists and those reviewed by musculoskeletal radiologists, higher-field-strength (3.0 T) MRI systems provided the greatest diagnostic test accuracy.
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Affiliation(s)
- Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, NR4 7TJ Norwich, UK.
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Hitachi S, Takase K, Tanaka M, Tojo Y, Tabata S, Majima K, Higano S, Takahashi S. High-resolution magnetic resonance imaging of rotator cuff tears using a microscopy coil: noninvasive detection without intraarticular contrast material. Jpn J Radiol 2011; 29:466-74. [PMID: 21882088 DOI: 10.1007/s11604-011-0583-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 03/01/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the feasibility of high-resolution magnetic resonance imaging (MRI) using a microscopy coil for the diagnosis of rotator cuff tears by comparing the method to conventional MRI and MRI arthrography. MATERIALS AND METHODS A total of 68 shoulders were prospectively studied using a 1.5-T MRI unit. Conventional MRI scans were obtained with a surface coil and high-resolution MRI scans with a microscopy coil. MRI arthrography was performed in 28 shoulders using a surface coil. MRI evaluation of tears of rotator cuff tendons was compared with arthroscopic findings and surgical results. RESULTS The surgery revealed 40 full-thickness tears, 13 partial-thickness tears, and 15 intact cuffs. In all, 35 (88%) full-thickness tears were correctly diagnosed on conventional MRI and 40 (100%) on high-resolution MRI. MR arthrography delineated 11 of 12 (92%) full-thickness tears. Altogether, 5 (38%) of the partial-thickness tears were detected on conventional MRI, and 12 (92%) were clearly demonstrated on high-resolution MRI. MRI arthrography depicted three (60%) of five partial-thickness tears. High-resolution MRI showed higher sensitivity than conventional MRI (P < 0.05) and had values equivalent to those of MRI arthrography for diagnosing partial-thickness tears. CONCLUSION High-resolution MRI with a microscopy coil is a feasible, noninvasive technique for diagnosing rotator cuff tears.
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Affiliation(s)
- Shin Hitachi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 981-8574, Japan.
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Chen HS, Lin SH, Hsu YH, Chen SC, Kang JH. A comparison of physical examinations with musculoskeletal ultrasound in the diagnosis of biceps long head tendinitis. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1392-1398. [PMID: 21767902 DOI: 10.1016/j.ultrasmedbio.2011.05.842] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/06/2011] [Accepted: 05/26/2011] [Indexed: 05/31/2023]
Abstract
Provocative tests are useful in diagnosing biceps tendon tendinitis. This is the first study to establish the reliability of these tests by comparing the resuts with musculoskeletal ultrasound (US) findings. This study examined 125 patients (69 women and 56 men) and 143 shoulders with shoulder pain. Yergason's test, Speed's test and a bicipital groove tenderness test were performed and musculoskeletal US findings were used as standard reference. Biceps tendon tendinitis was diagnosed with US in 39.1% of the patients and, of those, 55.3% had coexisting rotator cuff injury. The sensitivity and specificity of Yergason's test were 32% and 78%, respectively. The sensitivity and specificity of Speed's test were 63% and 58%, respectively. In conclusion, all three tests are limited by poor sensitivity. US can be an image modality choice in diagnosing biceps pathology.
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Affiliation(s)
- Hung-Sheng Chen
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
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Smith TO, Back T, Toms AP, Hing CB. Diagnostic accuracy of ultrasound for rotator cuff tears in adults: a systematic review and meta-analysis. Clin Radiol 2011; 66:1036-48. [PMID: 21737069 DOI: 10.1016/j.crad.2011.05.007] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 05/04/2011] [Accepted: 05/14/2011] [Indexed: 02/06/2023]
Abstract
AIM To determine the diagnostic accuracy of ultrasound to detect partial and complete thickness rotator cuff tears based on all available clinical trials. MATERIALS AND METHODS An electronic search of databases registering published and unpublished literature was conducted. All diagnostic accuracy studies that directly compared the accuracy of ultrasound (the index test) to either arthroscopic or open surgical findings (the reference test) for rotator cuff tear were included. The methodological quality of each included study was assessed using the QUADAS form. When appropriate, pooled sensitivity and specificity analysis was conducted, with an assessment of the summary receiver operating characteristic (ROC) curve for each analysis. RESULTS Sixty-two studies assessing 6007 patients and 6066 shoulders were included. Ultrasonography had good sensitivity and specificity for the assessment of partial thickness (sensitivity 0.84; specificity 0.89), and full-thickness rotator cuff tears (sensitivity 0.96; specificity 0.93). However, the literature poorly described population characteristics, assessor blinding, and was based on limited sample sizes. The literature assessing transducer frequency was particularly small in size. CONCLUSION Ultrasonography is an appropriate radiological technique for the assessment of rotator cuff tears with an acceptable sensitivity and specificity. The diagnostic test accuracy of ultrasound is superior for the detection of full-thickness compared to partial-thickness cuff tears. Further study assessing the effect of transducer frequency is warranted.
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Affiliation(s)
- T O Smith
- Department of Physiotherapy, University of East Anglia, Norwich, UK.
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Toussaint B, Schnaser E, Bosley J, Lefebvre Y, Gobezie R. Early structural and functional outcomes for arthroscopic double-row transosseous-equivalent rotator cuff repair. Am J Sports Med 2011; 39:1217-25. [PMID: 21427446 DOI: 10.1177/0363546510397725] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The arthroscopic double-row transosseous-equivalent (TOE) rotator cuff repair is growing in popularity. The current body of literature supports this technique; however, the number of patients in these studies is relatively small. The authors conducted this study to learn more about the natural history of this construct in a large sample of patients. HYPOTHESIS The double-row TOE rotator cuff repair will have an acceptable structural failure rate with improved clinical outcomes at 1-year follow-up. STUDY DESIGN Case series; Level of evidence, 4. METHODS Between June 2006 and October 2007, 225 patients underwent an all-arthroscopic rotator cuff repair at 2 surgical centers. A total of 155 TOE primary rotator cuff repairs were performed, and 154 of these patients met the inclusion criteria. Assessment of structural integrity was based on evaluation of postoperative magnetic resonance imaging or computed tomography arthrogram at a minimum of 12 months after surgery. The Constant scores, visual analog pain scale, range of motion, strength, and complications were the clinical outcomes analyzed for the study. Seventeen patients (of 154) had postoperative shoulder stiffness at follow-up. RESULTS The 154 patients were clinically and radiologically evaluated at a mean of 15 months postoperatively (range, 12-26.1 months). The study included 47 small (30.5%), 89 large (57.1%), and 19 massive (12.3%) rotator cuff tears. Analysis of postoperative imaging demonstrated that 92%, 83%, and 84% of the small, large, and massive rotator cuff tears, respectively, were intact. The mean Constant score improved from 44.42 points preoperatively to 80.47 points postoperatively (P < .001). The mean preoperative pain score improved from 3.83 to 12.77 (P < .001) postoperatively. The mean forward flexion improved from 123.06° preoperatively to 162.39° postoperatively (P < .001). Seventeen patients (of 154) had postoperative shoulder stiffness at follow-up. CONCLUSION The short-term results of this study indicate that the clinical outcomes and structural integrity of TOE double-row rotator cuff repair (the suture-bridge technique) have results that compare favorably with those reported for other double-row suture anchor techniques employed in rotator cuff repairs. Long-term follow-up will be necessary to determine if the durability of these repairs and the structural integrity of these constructs maintain their performance over time.
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Affiliation(s)
- Bruno Toussaint
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, OH 44106, USA
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Houtz CG, Schwartzberg RS, Barry JA, Reuss BL, Papa L. Shoulder MRI accuracy in the community setting. J Shoulder Elbow Surg 2011; 20:537-42. [PMID: 21440460 DOI: 10.1016/j.jse.2011.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 12/22/2010] [Accepted: 01/01/2011] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS/BACKGROUND Evaluate the accuracy for shoulder magnetic resonance imaging (MRI) interpretations of typical community radiologists and compare this to selected fellowship trained musculoskeletal radiologists. METHODS The MRIs of 104 shoulders of 100 consecutive different patients who had undergone shoulder arthroscopy by a single surgeon were included in this prospective study. The 104 typed MRI reports of community radiologists were examined, and the positive or negative findings were recorded for the anterior, superior, and posterior labra, and the long head biceps tendon and rotator cuff. The 104 MRIs were then interpreted by 2 fellowship trained musculoskeletal radiologists who were blinded to the nature of this study. They were asked to specifically comment on the same shoulder pathologies and to subjectively rate the quality of each MRI study using a visual analogue score (VAS). RESULTS The shoulder pathologies documented by arthroscopy included rotator cuff tears (55 full, 10 partial), labral tears (12 anterior, 17 posterior, 29 superior), and 31 biceps abnormalities. There were 69 noncontrast MRIs and 35 MRI arthrograms. Comparing the community radiologists' accuracies with the 2 selected musculoskeletal radiologists' accuracies, there were no significant differences for any of the shoulder pathologies studied. There was a significant positive correlation between VAS and accuracies for both musculoskeletal radiologists in diagnosing posterior labral tears only. The use of contrast in these MRIs only significantly improved both of the musculoskeletal radiologists' accuracies in diagnosing biceps lesions. CONCLUSION The accuracies for shoulder MRI in this community setting were not improved by having the MRIs interpreted by selected fellowship trained musculoskeletal radiologists.
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Painful poststroke shoulder: Comparison of magnetic resonance imaging and high frequency ultrasonography. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2011. [DOI: 10.1016/j.ejrnm.2011.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Sipola P, Niemitukia L, Kröger H, Höfling I, Väätäinen U. Detection and quantification of rotator cuff tears with ultrasonography and magnetic resonance imaging - a prospective study in 77 consecutive patients with a surgical reference. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:1981-1989. [PMID: 20965645 DOI: 10.1016/j.ultrasmedbio.2010.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 08/23/2010] [Accepted: 09/05/2010] [Indexed: 05/30/2023]
Abstract
The aim of this study was to compare the accuracy of ultrasonography (US) and magnetic resonance artrography (MRA) for the detection and measurement of rotator cuff tears, using surgical findings as a standard. A total of 77 consecutive patients with suspected rotator cuff tears were prospectively studied with US and MRA. Rotator cuff tears were identified by US with sensitivity, specificity, positive predictive and negative predictive values of 92%, 45%, 91% and 50%, respectively, and by MRA with values of 97%, 82%, 97% and 82%, respectively. US was not reliable for differentiating between partial and full thickness tears. US and MRA underestimated the tear sizes by an average of 15 mm and 4 mm, respectively. Our results suggest that US could be used as a screening test to confirm a suspected rotator cuff tear. In patients with negative findings, an MRA should be considered for substantiation.
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Affiliation(s)
- Petri Sipola
- Department of Clinical Radiology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
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Abstract
Suprascapular neuropathy has often been overlooked as a source of shoulder pain. The condition may be more common than once thought as it is being diagnosed more frequently. Etiologies for suprascapular neuropathy may include repetitive overhead activities, traction from a rotator cuff tear, and compression from a space-occupying lesion at the suprascapular or spinoglenoid notch. Magnetic resonance imaging is useful for visualizing space-occupying lesions, other pathological entities of the shoulder, and fatty infiltration of the rotator cuff. Electromyography and nerve conduction velocity studies remain the standard for diagnosis of suprascapular neuropathy; however, data on interobserver reliability are limited. Initial treatment of isolated suprascapular neuropathy is typically nonoperative, consisting of physical therapy, nonsteroidal anti-inflammatory drugs, and activity modification; however, open or arthroscopic operative intervention is warranted when there is extrinsic nerve compression or progressive pain and/or weakness. More clinical data are needed to determine if treatment of the primary offending etiology in cases of traction from a rotator cuff tear or compression from a cyst secondary to a labral tear is sufficient or whether concomitant decompression of the nerve is warranted for management of the neuropathy.
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Affiliation(s)
- Robert E Boykin
- Harvard Shoulder Service, Massachusetts General Hospital, 55 Fruit Street, Yawkey Center for Outpatient Care, Suite 3200, 3G, Room 3-046, Boston, MA 02114, USA
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Noh KC, Chung KJ, Yu HS, Koh SH, Yoo JH. Arthroscopic treatment of septic arthritis of acromioclavicular joint. Clin Orthop Surg 2010; 2:186-90. [PMID: 20808591 PMCID: PMC2915399 DOI: 10.4055/cios.2010.2.3.186] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2008] [Accepted: 01/16/2009] [Indexed: 12/16/2022] Open
Abstract
Septic arthritis requires an early diagnosis and proper treatment to prevent the destruction of articular cartilage and joint contracture. This paper presents a rare case of septic arthritis of the acromioclavicular joint that was treated with arthroscopic debridement and resection of the distal clavicle.
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Affiliation(s)
- Kyu Cheol Noh
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
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Fowler EM, Horsley IG, Rolf CG. Clinical and arthroscopic findings in recreationally active patients. BMC Sports Sci Med Rehabil 2010; 2:2. [PMID: 20157421 PMCID: PMC2821297 DOI: 10.1186/1758-2555-2-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 01/15/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the diagnostic accuracy of standard clinical tests for the shoulder in recreational athletes with activity related pain. DESIGN Cohort study with index test of clinical examination and reference standard of arthroscopy. SETTING Sports Medicine clinic in Sheffield, U.K. PARTICIPANTS 101 recreational athletes (82 male, 19 female; mean age 40.8 +/- 14.6 years) over a six year period. INTERVENTIONS Bilateral evaluation of movements of the shoulder followed by standardized shoulder tests, formulation of clinical diagnosis and shoulder arthroscopy conducted by the same surgeon. MAIN OUTCOME MEASUREMENTS Sensitivity, specificity, likelihood ratio for a positive test and over-all accuracy of clinical examination was examined retrospectively and compared with arthroscopy. RESULTS Isolated pathology was rare, most patients (72%) having more than one injury recorded. O'Brien's clinical test had a mediocre sensitivity (64%) and over-all accuracy (54%) for diagnosing SLAP lesions. Hawkins test and Jobe's test had the highest but still not impressive over-all accuracy (67%) and sensitivity (67%) for rotator cuff pathology respectively. External and internal impingement tests showed similar levels of accuracy. When a positive test was observed in one of a combination of shoulder tests used for diagnosing SLAP lesions or rotator cuff disease, sensitivity increased substantially whilst specificity decreased. CONCLUSIONS The diagnostic accuracy of isolated standard shoulder tests in recreational athletes was over-all very poor, potentially due to the majority of athletes (71%) having concomitant shoulder injuries. Most likely, this means that many of these injuries are missed in general practice and treatment is therefore delayed. Clinical examination of the shoulder should involve a combination of clinical tests in order to identify likely intra articular pathology which may warrant referral to specialist for surgery.
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Affiliation(s)
- Elizabeth M Fowler
- Centre for Health, Sport and Rehabilitation Sciences Research, University of Salford, Fredrick Road, Salford, UK
| | - Ian G Horsley
- Sheffield Centre of Sports Medicine, School of Biomedical Sciences, The University of Sheffield, Sheffield, UK
| | - Christer G Rolf
- Sheffield Centre of Sports Medicine, School of Biomedical Sciences, The University of Sheffield, Sheffield, UK
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Rotator cuff tears: should abduction and external rotation (ABER) positioning be performed before image acquisition? A CT arthrography study. Eur Radiol 2009; 20:1234-41. [DOI: 10.1007/s00330-009-1635-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 09/20/2009] [Accepted: 09/28/2009] [Indexed: 02/03/2023]
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Kang CH, Kim SS, Kim JH, Chung KB, Kim YH, Oh YW, Jeong WK, Kim BH. Supraspinatus tendon tears: comparison of 3D US and MR arthrography with surgical correlation. Skeletal Radiol 2009; 38:1063-9. [PMID: 19543893 DOI: 10.1007/s00256-009-0734-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 05/29/2009] [Accepted: 06/01/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of the study was to compare the diagnostic reliability of 3D US with MR arthrography in diagnosing supraspinatus tendon tears, with arthroscopic findings used as the standard. MATERIALS AND METHODS In a prospective study 50 patients who later underwent arthroscopic surgery of the rotator cuff were examined pre-operatively by 3D US with MR arthrography. The presence or absence of a full- or partial-thickness supraspinatus tendon tear and the tear size as demonstrated by each imaging and arthroscopy was recorded. The tear size was divided into three grades: small (<1 cm), medium (1-3 cm), and large (>3 cm). RESULTS The arthroscopic diagnosis was a full-thickness tear in 40 patients, partial-thickness tears in 5, and intact supraspinatus tendon in 5. 3D US correctly diagnosed 35 out of 40 full-thickness tears and MR arthrography 39 out of 40 full-thickness tears. Regarding partial-thickness tears, 3D US underestimated 2 cases as no tear and overestimated 1 case as a full-thickness tear. MR arthrography underestimated 1 case as a partial-thickness tear and overestimated 2 cases as full-thickness and partial-thickness tears respectively. 3D US and MR arthrography yield a sensitivity for full-thickness tears of 87.5% and 97.5% with specificity of 90.0% and 90.0%. Based on the grading system, 3D US measurements correctly predicted the tear size of 23 (65.7%) of the 35 full-thickness tears and MR arthrography 30 (75.0%) of the 39 full-thickness tears. CONCLUSION Three-dimensional ultrasound seems to be a promising imaging modality comparable to MR arthrography for the assessment of the supraspinatus tendon tears.
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Affiliation(s)
- Chang Ho Kang
- Department of Radiology, Kangwon National University Hospital, Kangwon-do, Korea
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Detection of rotator cuff tears: the value of MRI following ultrasound. Eur Radiol 2009; 20:450-7. [PMID: 19727754 PMCID: PMC2814028 DOI: 10.1007/s00330-009-1561-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 07/08/2009] [Accepted: 07/22/2009] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the need for additional magnetic resonance imaging (MRI) following ultrasound (US) in patients with shoulder pain and/or disability and to compare the accuracy of both techniques for the detection of partial-thickness and full-thickness rotator cuff tears (RCT). METHODS In 4 years, 5,216 patients underwent US by experienced musculoskeletal radiologists. Retrospectively, patient records were evaluated if MRI and surgery were performed within 5 months of US. US and MRI findings were classified into intact cuff, partial-thickness and full-thickness RCT, and were correlated with surgical findings. RESULTS Additional MR imaging was performed in 275 (5.2%) patients. Sixty-eight patients underwent surgery within 5 months. US and MRI correctly depicted 21 (95%) and 22 (100%) of the 22 full-thickness tears, and 8 (89%) and 6 (67%) of the 9 partial-thickness tears, respectively. The differences in performance of US and MRI were not statistically significant (p = 0.15). CONCLUSIONS MRI following routine shoulder US was requested in only 5.2% of the patients. The additional value of MRI was in detecting intra-articular lesions. In patients who underwent surgery, US and MRI yielded comparably high sensitivity for detecting full-thickness RCT. US performed better in detecting partial-thickness tears, although the difference was not significant.
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Accuracy of MRI, MR Arthrography, and Ultrasound in the Diagnosis of Rotator Cuff Tears: A Meta-Analysis. AJR Am J Roentgenol 2009; 192:1701-7. [DOI: 10.2214/ajr.08.1241] [Citation(s) in RCA: 430] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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AGNELLO KIMBERLYA, PUCHALSKI SARAHM, WISNER ERIKR, SCHULZ KURTS, KAPATKIN AMYS. EFFECT OF POSITIONING, SCAN PLANE, AND ARTHROGRAPHY ON VISIBILITY OF PERIARTICULAR CANINE SHOULDER SOFT TISSUE STRUCTURES ON MAGNETIC RESONANCE IMAGES. Vet Radiol Ultrasound 2008; 49:529-39. [DOI: 10.1111/j.1740-8261.2008.00429.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
Diagnostic imaging in a patient with shoulder pain should be used only after a comprehensive clinical evaluation of the shoulder. X-ray and ultrasonography are the basic diagnostic tools; computed tomography and magnetic resonance imaging (MRI) should be used only with certain indications. Ultrasonography and MRI have comparable accuracy for identifying and measuring full-thickness rotator cuff tears, but the accuracy for identifying partial-thickness still needs to be improved. MR arthrography has significantly improved sensitivity and specificity for partial-thickness tears of the cuff. Only ultrasound provides a real-time examination tool during shoulder movements. Moreover, dynamic ultrasonography can assess the contraction patterns of the supraspinatus and infraspinatus muscles, which may improve decision making in the treatment of shoulder diseases. In depicting fatty atrophy of the supraspinatus and infraspinatus muscles, MRI remains the reference standard. MRI should not be used as a diagnostic screening tool in patients with chronic shoulder pain because it does not appear to significantly affect treatment or outcome.
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Affiliation(s)
- A Hedtmann
- Orthopädische Abteilung Klinik Fleetinsel Hamburg, Admiralitätstrasse 3, 20249 Hamburg, Deutschland.
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Martin D, Jeer PJS, Kalairajah Y, Falworth M, Zadow S, Simmons N. Air bubble saline arthrosonography in imaging rotator cuff tears. Orthopedics 2008; 31:140-2. [PMID: 18323257 DOI: 10.3928/01477447-20080201-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Rotator Cuff Impingement: Correlation Between Findings on MRI and Outcome After Fluoroscopically Guided Subacromial Bursography and Steroid Injection. AJR Am J Roentgenol 2007; 189:1179-84. [DOI: 10.2214/ajr.07.2421] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kim HA, Kim SH, Seo YI. Ultrasonographic findings of the shoulder in patients with rheumatoid arthritis and comparison with physical examination. J Korean Med Sci 2007; 22:660-6. [PMID: 17728506 PMCID: PMC2693816 DOI: 10.3346/jkms.2007.22.4.660] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The objectives of this study were: 1) to identify the ultrasonographic (US) abnormalities and 2) to compare the findings of physical examination with US findings in rheumatoid arthritis (RA) patients with shoulder pain. We studied 30 RA patients. Physical examination was performed systemically as follows: 1) area of tenderness; 2) range of passive and active shoulder motion; 3) impingement tests; 4) maneuvers for determining the location of the tendon lesions. US investigations included the biceps, the supraspinatus, infraspinatus, and subscapularis tendons; the subacromial-subdeltoid bursa; and the glenohumeral and acromioclavicular joints. Thirty RA patients with 35 painful and 25 non-painful shoulders were examined. The range of motion affected the most by shoulder pain was abduction. The most frequent US finding of shoulder joint was effusion in the long head of the biceps tendon. Among the rotator cuff tendons, subscapularis was the most frequently involved. Tendon tear was also common among non-painful shoulders. Physical examination used for the diagnosis of shoulder pain had low sensitivity and specificity for detecting abnormalities in the rheumatoid shoulder joint. In conclusion, US abnormalities showed frequent tendon tears in our RA patients. Physical examination had low sensitivity and specificity for detecting rotator cuff tear in the rheumatoid shoulder joint.
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Affiliation(s)
- Hyun Ah Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
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43
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Lafosse L, Brozska R, Toussaint B, Gobezie R. The Outcome and Structural Integrity of Arthroscopic Rotator Cuff Repair with Use of the Double-Row Suture Anchor Technique. J Bone Joint Surg Am 2007. [DOI: 10.2106/00004623-200707000-00018] [Citation(s) in RCA: 177] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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44
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Suder PA, Hougaard K, Frich LH, Rasmussan OS, Lundorf E. Diagnostic evaluation of athletes with posttraumatic chronic shoulder pain. Scand J Med Sci Sports 2007. [DOI: 10.1111/j.1600-0838.1994.tb00427.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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45
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Suder PA, Hougaard K. Posterior detachment of the glenoid labrum in athletes with posttraumatic chronic shoulder pain. Scand J Med Sci Sports 2007. [DOI: 10.1111/j.1600-0838.1994.tb00437.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Stecco A, Brambilla M, Puppi AMA, Lovisolo M, Boldorini R, Carriero A. Shoulder MR arthrography: In vitro determination of optimal gadolinium dilution as a function of field strength. J Magn Reson Imaging 2007; 25:200-7. [PMID: 17152058 DOI: 10.1002/jmri.20788] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To find the optimal contrast agent dilution to maximize signal intensity (SI), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in shoulder MR arthrography using MR systems operating at different magnetic field strengths. MATERIALS AND METHODS Autoptic human glenohumeral ligaments were inserted in eight egg-shaped 20-mL phantoms filled with saline and gadolinium diethylenetriaminepentaacetic acid bismethylamide (Gd-DTPA-BMA) in different dilutions of 0.5, 1, 2, 2.5, 5, 12.5, 50 mmol/liter, to simulate the shoulder articular capsule. These phantoms were inserted inside two plastic 240-mL phantoms filled with water. MRI was performed on 0.2-, 0.5-, 1.0-, 1.5-, and 3.0-T MR systems using a three-dimensional gradient echo (GRE)-T1-weighted pulse sequence. SI, SNR, and CNR were determined. RESULTS Peak SI and SNR were found at 5 mmol/liter, with the exception of the 0.2-T scanner, where the maximum was at 2 mmol/liter. Peak CNR was observed at 1 mmol/liter for the 3-T scanner, at 2 mmol/liter for the 0.2- and 0.5-T scanners, and at 5 mmol/liter for the remaining scanners. CONCLUSION The optimal SI and SNR are provided by 5 mmol/liter contrast agent dilution. Peak CNR was found in a range between 1 and 5 mmol/liter dilutions, depending on the strength of the magnetic field.
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Affiliation(s)
- Alessandro Stecco
- Radiology Department, Maggiore della Carità Hospital, Eastern Piedmont University, Novara, Italy.
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Waldt S, Bruegel M, Mueller D, Holzapfel K, Imhoff AB, Rummeny EJ, Woertler K. Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation. Eur Radiol 2006; 17:491-8. [PMID: 16969638 DOI: 10.1007/s00330-006-0370-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Revised: 04/20/2006] [Accepted: 06/19/2006] [Indexed: 01/15/2023]
Abstract
We assessed the diagnostic performance of magnetic resonance (MR) arthrography in the diagnosis of articular-sided partial-thickness and full-thickness rotator cuff tears in a large symptomatic population. MR arthrograms obtained in 275 patients including a study group of 139 patients with rotator cuff tears proved by arthroscopy and a control group of 136 patients with arthroscopically intact rotator cuff tendons were reviewed in random order. MR imaging was performed on a 1.0 T system (Magnetom Expert, Siemens). MR arthrograms were analyzed by two radiologists in consensus for articular-sided partial-thickness and full-thickness tears of the supraspinatus, infraspinatus, and subscapularis tendons. At arthroscopy, 197 rotator cuff tears were diagnosed, including 105 partial-thickness (93 supraspinatus, nine infraspinatus, three subscapularis) and 92 full-thickness (43 supraspinatus, 20 infraspinatus, 29 subscapularis) tendon tears. For full-thickness tears, sensitivity, specificity, and accuracy were 96%, 99%, and 98%, respectively, and for partial tears 80%, 97%, and 95%, respectively. False negative and positive assessments in the diagnosis of articular-sided partial-thickness tears were predominantly [78% (35/45)] observed with small articular-sided (Ellman grade1) tendon tears. MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears and is accurate in the diagnosis of articular-sided partial-thickness tears. Limitations in the diagnosis of partial-thickness tears are mainly restricted to small articular-sided tears (Ellman grade 1) due to difficulties in differentiation between fiber tearing, tendinitis, synovitic changes, and superficial fraying at tendon margins.
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Affiliation(s)
- S Waldt
- Department of Radiology, Technische Universität München, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675 Munich, Germany.
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Rutten MJCM, Jager GJ, Blickman JG. From the RSNA refresher courses: US of the rotator cuff: pitfalls, limitations, and artifacts. Radiographics 2006; 26:589-604. [PMID: 16549619 DOI: 10.1148/rg.262045719] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
High-resolution ultrasonography (US) has gained increasing popularity as a diagnostic tool for assessment of the soft tissues in shoulder impingement syndrome. US is a powerful and accurate method for diagnosis of rotator cuff tears and other rotator cuff abnormalities, provided the examiner has a detailed knowledge of shoulder anatomy, uses a standardized examination technique, and has a thorough understanding of the potential pitfalls, limitations, and artifacts. False-positive sonographic findings of rotator cuff tears can be caused by the technique (anisotropy, transducer positioning, acoustic shadowing by the deltoid septum), by the anatomy (rotator cuff interval, supraspinatus-infraspinatus interface, musculotendinous junction, fibrocartilaginous insertion), or by disease (criteria for diagnosis of rotator cuff tears, tendon inhomogeneity, acoustic shadowing by scar tissue or calcification, rotator cuff thinning). False-negative sonographic findings of rotator cuff tears can be caused by the technique (transducer frequency, suboptimal focusing, imaging protocol, transducer handling), by the anatomy (nondiastasis of the ruptured tendon fibers, posttraumatic obscuration of landmarks), by disease (tendinosis, calcifications, synovial proliferation, granulation or scar tissue, bursal thickening, massive rotator cuff tears), or by patient factors (obesity, muscularity, limited shoulder motion).
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Affiliation(s)
- Matthieu J C M Rutten
- Department of Radiology, Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL s-Hertogenbosch, the Netherlands.
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Hirano Y, Sashi R, Izumi J, Itoi E, Watarai J. Comparison of the MR findings on indirect MR arthrography in patients with rotator cuff tears with and without symptoms. ACTA ACUST UNITED AC 2006; 24:23-7. [PMID: 16715658 DOI: 10.1007/bf02489985] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare indirect magnetic resonance (MR) arthrography findings in patients with rotator cuff tears with and without symptoms. MATERIALS AND METHODS Indirect MR arthrography results of 15 asymptomatic and 23 symptomatic rotator cuff tears were retrospectively reviewed, comparing the type and size of tears and amount of subacrominal-subdeltoid bursal fluid. RESULTS There were 14 partial-thickness tears and one full-thickness tear in the asymptomatic group, with 4 small and 11 medium tears. In the symptomatic group, there were 16 partial-thickness and 7 full-thickness tears, with 14 small, 5 medium, and 4 large tears. In the asymptomatic group, the amount of subacrominal-subdeltoid bursal fluid was grade 0, 6 patients; grade 1, 6 patients; grade 2, 2 patients; and grade 3, 1 patient. In the symptomatic group, the amount of subacrominal-subdeltoid bursal fluid was grade 0, 4 patients; grade 1, 3 patients; grade 2, 8 patients; and grade 3, 8 patients. We found no statistically significant difference between symptomatic and asymptomatic tears in the kind and size of tears, and in the amount of subacrominal-subdeltoid bursal fluid. CONCLUSION We found no difference in the MR findings between symptomatic and asymptomatic rotator cuff tears.
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Reilly P, Macleod I, Macfarlane R, Windley J, Emery RJH. Dead men and radiologists don't lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. Ann R Coll Surg Engl 2006; 88:116-21. [PMID: 16551396 PMCID: PMC1964063 DOI: 10.1308/003588406x94968] [Citation(s) in RCA: 205] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Rotator cuff tears are a common pathology, with a varied prevalence reported. PATIENTS AND METHODS A literature review was undertaken to determine the cadaveric and radiological (ultrasonography and magnetic resonance imaging [MRI]) prevalence of rotator cuff tear. The radiological studies were subdivided into symptomatic and asymptomatic subjects. RESULTS Cadaveric rotator cuff tears were found in 4629 shoulders of which only 2553 met the inclusion criteria. The prevalence of full-thickness tears was 11.75% and partial thickness 18.49% (total tears 30.24%). The total tear rate in ultrasound asymptomatic was 38.9% and ultrasound symptomatic 41.4%. The total rate in MRI asymptomatic was 26.2% whilst MRI symptomatic was 49.4%. DISCUSSION The unselected cadaveric population should contain both symptomatic and asymptomatic subjects. A prevalence of tears between the symptomatic and asymptomatic radiological groups would be expected. However, apart from the MRI asymptomatic group, the radiological prevalence of rotator cuff tears exceeds the cadaveric. CONCLUSIONS Rotator cuff tears are frequently asymptomatic. Tears demonstrated during radiological investigation of the shoulder may be asymptomatic. It is important to correlate radiological and clinical findings in the shoulder.
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Affiliation(s)
- P Reilly
- Department Orthopaedic Surgery, St Mary's Hospital, London, UK
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