Greater tuberosity changes as revealed by radiography: lack of clinical usefulness in patients with rotator cuff disease

Abstract

Objective: Studies linking greater tuberosity findings on radiographs with rotator cuff disease have largely been uncontrolled and biased toward more severe disease. We correlated greater tuberosity changes seen on radiography with rotator cuff disease seen on MR images in a broadly symptomatic patient population.

Materials and methods: Both radiography and MR imaging were performed in 108 shoulders. Unaware of the MR imaging findings, three radiologists independently reviewed the radiographs for cortical thickening, subcortical sclerosis, and cystlike lesions in the humeral greater tuberosity. Interobserver agreement was analyzed using kappa statistics. We correlated the radiographic findings with MR imaging evidence of rotator cuff tears and tendonopathy. The positive predictive value of each finding for rotator cuff disease was also calculated.

Results: Interobserver agreement for the three radiographic findings was poor to fair: Kappa values ranged from .06 to .41. Cortical thickening and subcortical sclerosis were not seen more frequently in shoulders with rotator cuff disease than in normal shoulders. Cystlike lesions were more prevalent in shoulders with rotator cuff disease, but the association reached statistical significance (p < .05) for one observer only. Positive predictive values for each finding were low (14-48% for predicting full-thickness rotator cuff tears).

Conclusion: Cortical thickening of the greater tuberosity and subcortical sclerosis are not associated with rotator cuff disease. For some observers, identifying cystlike lesions is associated with rotator cuff disease, but the clinical usefulness of the observation is limited by high interobserver variability and poor positive predictive value.