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Quantitative diagnosis of rotator cuff tears based on sonographic pattern recognition.

ABSTRACT: The lifetime prevalence of shoulder pain is nearly 70% and is mostly attributable to subacromial disorders. A rotator cuff tear is the most severe form of subacromial disorders, and most occur in the supraspinatus. For clinical examination, shoulder ultrasound is recommended to detect supraspinatus tears. In this study, a computer-aided tear classification (CTC) system was developed to identify supraspinatus tears in ultrasound examinations and reduce inter-operator variability. The observed cases included 89 ultrasound images of supraspinatus tendinopathy and 102 of supraspinatus tear from 136 patients. For each case, intensity and texture features were extracted from the entire lesion and combined in a binary logistic regression classifier for lesion classification. The proposed CTC system achieved an accuracy rate of 92% (176/191) and an area under receiver operating characteristic curve (Az) of 0.9694. Based on its diagnostic performance, the CTC system has promise for clinical use.

SUBMITTER: Chang RF

PROVIDER: S-EPMC6394937 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Quantitative diagnosis of rotator cuff tears based on sonographic pattern recognition.

Chang Ruey-Feng RF Lee Chung-Chien CC Lo Chung-Ming CM

PloS one 20190228 2

The lifetime prevalence of shoulder pain is nearly 70% and is mostly attributable to subacromial disorders. A rotator cuff tear is the most severe form of subacromial disorders, and most occur in the supraspinatus. For clinical examination, shoulder ultrasound is recommended to detect supraspinatus tears. In this study, a computer-aided tear classification (CTC) system was developed to identify supraspinatus tears in ultrasound examinations and reduce inter-operator variability. The observed cas ...[more]

PMID: 30817804

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Project description:BackgroundThe purposes of this study were to identify changes in tear dimensions, shoulder function, and glenohumeral kinematics when an asymptomatic rotator cuff tear becomes painful and to identify characteristics of individuals who develop pain compared with those who remain asymptomatic.MethodsA cohort of 195 subjects with an asymptomatic rotator cuff tear was prospectively monitored for pain development and examined annually for changes in various parameters such as tear size, fatty degeneration of the rotator cuff muscle, glenohumeral kinematics, and shoulder function. Forty-four subjects were found to have developed new pain, and the parameters before and after pain development were compared. The forty-four subjects were then compared with a group of fifty-five subjects who remained asymptomatic over a two-year period.ResultsWith pain development, the size of a full-thickness rotator cuff tear increased significantly, with 18% of the full-thickness tears showing an increase of >5 mm, and 40% of the partial-thickness tears had progressed to a full-thickness tear. In comparison with the assessments made before the onset of pain, the American Shoulder and Elbow Surgeons scores for shoulder function were significantly decreased and all measures of shoulder range of motion were decreased except for external rotation at 90° of abduction. There was an increase in compensatory scapulothoracic motion in relation to the glenohumeral motion during early shoulder abduction with pain development. No significant changes were found in external rotation strength or muscular fatty degeneration. Compared with the subjects who remained asymptomatic, the subjects who developed pain were found to have significantly larger tears at the time of initial enrollment.ConclusionsPain development in shoulders with an asymptomatic rotator cuff tear is associated with an increase in tear size. Larger tears are more likely to develop pain in the short term than are smaller tears. Further research is warranted to investigate the role of prophylactic treatment of asymptomatic shoulders to avoid the development of pain and loss of shoulder function.

Project description:PurposeTo determine whether anterior cable tears could be identified at the time of arthroscopic rotator cuff repair and determine the characteristics of the anterior cable tears identified.MethodsFrom 2016 to 2017 all shoulder arthroscopies had data collected prospectively at the time of surgery, specifically including injury to the capsular and tendon zones of insertion on the greater tuberosity. Anterior cable position and degree of injury and medialization were recorded, as well as complete findings of the diagnostic arthroscopy. The inclusion criterion was primary shoulder arthroscopy. The exclusion criterion was any revision shoulder arthroscopy. All arthroscopic rotator cuff repairs (ARCR) were grouped together and all other nonarthroscopic rotator cuff repair surgeries (non-ARCR) were grouped together.ResultsIn total, 118 shoulder arthroscopies had data collected prospectively at the time of surgery: 90 primary shoulder arthroscopies met the inclusion criteria; 28 were excluded because they were revision surgeries. There were 42 patients in the ARCR group (Group 1). Six of these were partial tears, and 36 were full-thickness tears. There were 48 patients in the non-ARCR group (Group 2). The non-ARCR Group 2 served as an anatomic baseline for ARCR Group 1. In all 90 shoulders, the rotator cable and anterior cable were identified. Group 1 (ARCR) incidence of anterior cable tears with abnormal position was 71.4% compared to 2.1% in group 2 (non-ARCR) (P < .001) Group 1 (ARCR) incidence of anterior cable tears with normal anterior cable position (n = 12) was compared to abnormal anterior cable position (n = 30). Injury to the anterior footprint capsular and tendon zones were compared. Normal anterior cable position correlated with no or low-grade injury to anterior footprint capsular zone. (Nimura zone C1). Abnormal anterior cable displacement graded as moderate (n = 20) and severe (n = 10) were compared for injury to the anterior footprint. Moderate displacement correlated with complete or high grade injury to C1 in 85% and complete injury to R1 in 45% (P < .001 and .049). In severe displacement complete C1 injury was 100%, and complete R1 injury was 100% (P < .001 and .001).ConclusionsAnterior cable tears are universally identified in ARCR. Three patterns of medial displacement severity correlated with injury to a crucial insertion zone (C1) at the anterior footprint. The degree of anterior cable disruption at the anterior footprint and displacement was commonly disproportionately greater than the injury to the supraspinatus.Level of evidenceLevel III, diagnostic study.

Project description:BackgroundTendon transfers of the latissimus dorsi transfer (LDT) or the lower trapezius transfer (LTT) are treatment options for irreparable posterosuperior irreparable rotator cuff tears (PSIRCT). There is still no consensus on which type of tendon transfer is superior in the treatment of PSIRCT. Due to the differences in the anatomy and biomechanics, we hypothesize that there are different clinical situations in which either LDT or LTT should be preferred. The aim of this study was to evaluate the clinical and radiological outcomes of LDT and LTT in patients with PSIRCT to establish a clinical algorithm for the treatment decision.Materials and methodsThis is a retrospective, single-center observational study. Included were patients who underwent arthroscopically assisted LDT (aaLDT) or arthroscopically assisted LTT (aaLTT) for PSIRCT. In all patients, range of motion (ROM), external rotation strength, visual analog scale of pain and subjective shoulder value were determined pre- and postoperatively. Constant-Murley score was evaluated at the final follow-up. The complication rate, failure of the tendon transfer, and revision rate were analyzed.ResultsIn total, 29 aaLDT (age 64 years, median follow-up time 45 months) and 8 aaLTT (age 54 years, median follow-up time 34 months) were included. Active ROM, visual analog scale and subjective shoulder value was significantly improved in both cohorts. At follow-up, the median Constant-Murley score was 73 (aaLDT) and 77 (aaLTT), respectively. The failure rate, including revision surgery, was 14% (aaLDT) and 13% (aaLTT), respectively. Low functional findings preoperatively were correlated to a lower functional outcome at follow-up in both groups. Painful loss of anterior elevation and loss of external rotation had no significant impact on functional outcomes in aaLDT.ConclusionFollowing the treatment algorithm based on the clinical examination, clinical outcome parameters, active ROM and pain could be significantly improved. A good preoperative function was associated with a good clinical outcome in both transfers. A low failure and revision rate supports the good decision-making of the algorithm presented.

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Quantitative diagnosis of rotator cuff tears based on sonographic pattern recognition.

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Quantitative diagnosis of rotator cuff tears based on sonographic pattern recognition.

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