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. 2021 Mar 29;5(3):424-429.
doi: 10.1016/j.jseint.2021.01.014. eCollection 2021 May.

Less than 9.5-mm coracohumeral distance on axial magnetic resonance imaging scans predicts for subscapularis tear

Thomas Reichel  1 , Stefan Herz  2 , Mohammed El Tabbakh  1 , Thorsten Alexander Bley  2 , Piet Plumhoff  1 , Kilian Rueckl  1
Affiliations

Less than 9.5-mm coracohumeral distance on axial magnetic resonance imaging scans predicts for subscapularis tear

Thomas Reichel et al. JSES Int. .

Abstract

Background: Diagnosis of subscapularis (SSC) tendon lesions on magnetic resonance imaging (MRI) can be challenging. A small coracohumeral distance (CHD) has been associated with SSC tears. This study was designed to define a specific threshold value for CHD to predict SSC tears on axial MRI scans.

Methods: This retrospective study included 172 shoulders of 168 patients who underwent arthroscopic surgery for rotator cuff tear or glenohumeral instability. Diagnostic arthroscopy confirmed an SSC tear in 62 cases (36.0%, test group a), rotator cuff tear tears other than SSC in 71 cases (41.3%, control group b) and glenohumeral instability without any rotator cuff tear in 39 cases (22.7%, zero-sample group c). All patients had a preoperative MRI of the shoulder (1.5T or 3T). Minimum CHD was measured on axial fat-suppressed proton density-, T2-, or T1-weigthed sequences. Receiver operating characteristics analysis was used to determine the threshold value for CHD, and sensitivity and specificity were calculated.

Results: CHD measurement had a good interobserver reliability (Intraclass correlation coefficient 0.799). Mean CHD was highly significantly (P < .001) less for test group a (mean 7.3 mm, standard deviation ± 2.2) compared with control group b (mean 11.1 mm, standard deviation ± 2.3) or zero-sample group c (mean 13.6 mm, standard deviation ± 2.9). A threshold value of CHD <9.5 mm had a sensitivity of 83.6% and a specificity of 83.9% to predict SSC tears.

Conclusion: A CHD <9.5 mm on MRI is predictive of SSC lesions and a valuable tool to diagnose SSC tears.

Keywords: Coracohumeral distance; Coracohumeral impingement; Rotator cuff tear; Subscapularis tear.

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Figures

Figure 1
Figure 1
Images showing a normal CHD of 12 mm (Left, a) and a narrowed CHD of 7 mm (Right, b) with arthroscopically confirmed SSC lesion; C, coracoid; H, humeral head; CHD, coracohumeral distance; SSC, subscapularis.
Figure 2
Figure 2
Box plots of CHD measurements with mean and standard deviation. The mean CHD for group A = rupture of the SSC tendon (Left, 7.3 mm, SD 2.2) was highly significantly (P < .001) less compared with group C = instability (Right, 13.6 mm, SD 2.9) or group B = other RC rupture (Middle, 11.1 mm, SD 2.3). CHD, coracohumeral distance; SSC, subscapularis.
Figure 3
Figure 3
ROC curve for different CHD values to predict an SSC tear and (group A vs. group B and group C). Optimal cutoff of 9.5 mm leads to a sensitivity of 83.6% and specificity of 83.9%. CHD, coracohumeral distance; SSC, subscapularis.
Figure 4
Figure 4
ROC curve for different CHD to predict SSC tear (group A vs. group C). Without other RC tears, the cut-off of 9.5 mm leads to a sensitivity of 94.9% with a specificity of 83.9%. CHD, coracohumeral distance; SSC, subscapularis.
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