What is the most predictive magnetic resonance imaging finding of rotator cuff tear concomitant with shoulder stiffness?

Abstract

Background: Common magnetic resonance imaging (MRI) findings in adhesive capsulitis are not often evident in rotator cuff tear concomitant with shoulder stiffness. This study aimed to determine the most predictive MRI finding of rotator cuff tear with shoulder stiffness to differentiate from that without stiffness.

Materials and methods: The data of patients who underwent arthroscopic rotator cuff repair between January 2014 and October 2019 were retrospectively reviewed. Stiffness was defined as forward flexion <120°, external rotation at side <30°, and internal rotation at back <L3 in the active range of motion. Propensity score matching (1-to-1) was performed between the stiff and control groups by sex, age, and tear size, and 76 patients per group were matched. Anterior capsular thickness, maximal humeral/glenoid capsular thickness in the axillary recess, coracohumeral ligament thickness, the presence of hyperintensity in the anterior capsule and humeral/glenoid capsule in the axillary recess, and hyperintensity and obliteration of the subcoracoid fat triangle were evaluated.

Results: Anterior capsular thickness, glenoid capsular thickness in the axillary recess, and anterior and axillary capsular hyperintensities were significantly more dominant in the stiff group (all P < .05) than in the control group. Anterior capsular thickness and anterior capsular abnormal hyperintensity could be used to differentiate between the stiff and control groups (P < .05). Anterior capsular thickness showed high diagnostic performance with an area under the receiver operating characteristic curve of 0.993. The cut-off value for stiffness was 3.07 mm (sensitivity, 96.1%; specificity, 100%).

Conclusion: Anterior capsular thickening and abnormal hyperintensity were the most predictive MRI findings for stiffness in patients with rotator cuff tear and stiffness to differentiate from patients with rotator cuff tear without stiffness.

Keywords: Adhesive capsulitis; Anterior capsular abnormal hyperintensity; Anterior capsular thickness; Magnetic resonance imaging; Rotator cuff tear; Stiff shoulder.

Figure 1

Reference and method of measurement for (a) forward flexion, (b) external rotation at the side, and (c) internal rotation (1, reference point, 2, point reached by arm). ∗ The reference point for forward flexion; the thoracic vertebrae.

Figure 2

Study design. MRA, magnetic resonance arthrography; MRI, magnetic resonance imaging; RCR, rotator cuff repair; RCT, rotator cuff tear.

Figure 3

Measurements of quantitative MRI variables. (a) MRI of a 72-year-old man with rotator cuff tear and shoulder stiffness. Axial fat-suppressed T2-weighted MR image showing prominent thickening of the anterior joint capsule. The anterior capsule is located from the anterior 2 to 5 o’clock position of the glenohumeral joint capsule, deep to the subscapularis (double yellow arrow, 3.83 mm). (b) MRI of a 56-year-old man with rotator cuff tear and shoulder stiffness. Oblique coronal fat-suppressed T2-weighted image showing measurement of the thickest portion of the axillary joint capsule in both humeral (double yellow arrow, 4.13 mm) and glenoid (double yellow arrow, 4.39 mm) attachments. (c) MRI of a 71-year-old woman with rotator cuff tear and shoulder stiffness. Oblique sagittal T2-weighted image showing measurement of the coracohumeral ligament thickness (double yellow arrow, 1.79 mm). MRI, magnetic resonance imaging.

Figure 4

Measurements of qualitative MRI variables. (a) MRI of a 71-year-old woman with rotator cuff tear and shoulder stiffness. Axial fat-suppressed T2-weighted MR image showing measurement of anterior capsular hyperintensity. Significant abnormal hyperintensity of the anterior joint capsule. (b) MRI of a 53-year-old woman with rotator cuff tear and shoulder stiffness. Oblique coronal fat-suppressed T2-weighted image showing axillary capsular thickening and abnormal hyperintensity. Increased thickness at the glenoid (4.05 mm) and humeral (3.81 mm) portions and T2 signal hyperintensity of the axillary joint capsule (yellow arrow). (c) MRI of a 53-year-old woman with rotator cuff tear and shoulder stiffness. Oblique coronal fat-suppressed T2-weighted image at the coracoid process (C) level showing abnormal hyperintensity at the subcoracoid fat triangle (yellow arrow). (d) MRI of a 53-year-old woman with rotator cuff tear and shoulder stiffness. Oblique sagittal T1-weighted image showing obliteration of the subcoracoid fat triangle (yellow arrow). MRI, magnetic resonance imaging.

Figure 5

ROC analysis of anterior capsular thickness (area under the ROC curve = 0.993, P < .001). The cut-off value of anterior capsular thickness for diagnosing stiffness was 3.07 mm, with a sensitivity of 96.1% and a specificity of 100%. ROC, receiver operating characteristic.