Prediction of the anterior shoulder pain source by detecting indirect signs for partial articular subscapularis tendon t
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SHOULDER
Prediction of the anterior shoulder pain source by detecting indirectsigns for partial articular subscapularis tendon tears throughconventional magnetic resonance imaging Ji Ho Lee1 · In Hyeok Rhyou1 · Kee Baek Ahn1 Received: 4 November 2019 / Accepted: 28 August 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose To evaluate the diagnostic efficacy of indirect signs for proximal articular-positioned, partial ( 90%). The Chi-squared test and multinomial logistic regression confirmed the significance of small defects, SSRs, and fatty infiltrations for facet 1 tears (p ≤ 0.014). The combined sensitivity and specificity were up to 97.7% and 92.3%, respectively, in the presence of either a small defect or an SSR. Conclusions Conventional MRI alone can detect facet 1 tears through indirect signs (small defects, SSR, and fatty infiltrations of the subscapularis muscle), predicting unspecified anterior shoulder pain due to concealed biceps instability, and facilitating preoperative diagnosis for a facet 1 tear. Level of evidence III. Keywords Subscapularis tendon tear · MRI · Superior subscapularis recess · Long head of biceps · Lesser tuberosity · Fatty infiltration
Introduction Subscapularis tendon tears have come into the spotlight as a source of anterior shoulder pain and dysfunction in the shoulder joint. With advances in arthroscopic techniques, recent reports have suggested that subscapularis tendon tears were present in 27.4–50.5% of other pathologies [3, 4, 6, 36]. However, the diagnosis of partial articular subscapularis tendon tears via magnetic resonance imaging (MRI) can be * In Hyeok Rhyou [email protected] 1
Department of Orthopedic Surgery, Pohang Semyeong Christianity Hospital, 351, Poscodaero, NamKu, Pohang, Gyungbuk, South Korea
difficult, so they are easily missed [10, 28, 29]. Conventional MRI scans may only accurately detect 69% of the subscapularis tendon tears while they provide highly accurate detection of supraspinatus and infraspinatus tendon tears [29]. In clinical situations, there are many cases of unspecified shoulder pain that cannot be detected with conventional MRI, and some reports have emphasized that concealed biceps instabilities can develop by partial articular subscapularis tendon tears [12, 18, 27]. Accordingly, we have questioned whether conventional MRI scans contained clues for partial articular tears of the subscapularis tendon, which can be shoulder joint pain generators accompanied by a pathology of the long head of the biceps tendon (LHBT) [16]. Yoo et al. introduced a three-dimensional insertion concept of the subscapularis tendon, in which the insertion was divided into four quadrilateral facets with angular
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distinctions. In particular, the most proximally positioned facet 1 is at a 58.2° inclination relative to the humeral shaft, making it difficult to locate in the coronal and axial views of MRI scans [36]. Pfirrmann et al. reported several signs for tears in the subsc
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