Observer variability in the assessment of the acromiohumeral interval using anteroposterior shoulder radiographs

Abstract

Background: An acromiohumeral interval narrower than 6 mm measured on AP shoulder radiographs has been considered pathological and suggestive of rotator cuff tears. This prospective study was conducted to assess inter- and intraobserver variation in the radiographic assessment of the acromiohumeral interval and its critical value on routinely taken AP shoulder radiographs off-study use to evaluate the accuracy of this measurement method.

Methods: The acromiohumeral distance from the inferior anterior acromial aspect to the humeral head was measured in millimeters. Thirty blinded, anteroposterior shoulder radiographs were independently reviewed by five board-certified orthopedic shoulder surgeons at two time points in random order.

Results: The results of three investigators showed significant intraobserver variation. Five investigator pairs showed significant interobserver variation at both examination time points. The maximum interobserver difference for the same radiograph was 8 mm (range 0 to 8 mm).

Conclusion: Our results indicate that the assessment of the acromiohumeral interval using non-standardized anteroposterior radiographs off-study use cannot be seen as a reproducible and reliable method of measurement.