• Rotator Cuff Tears; A rotator cuff tear is a common cause of pain and disability among adults. In 2008, close to 2 million people in the United States went to their doctors because of a rotator cuff problem. A torn rotator cuff will weaken your shoulder and cause pain. Daily activities, like combing your hair or getting dressed, may become.
• Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone). A partial tear, however, may need only a trimming or smoothing procedure called a debridement. This article contains details about these and other surgical treatments commonly used for rotator cuff tears.

• Dmg Orthopedics Mri Of Rotator Cuff Tear Symptoms
• Mri For Determining Rotator Cuff Tear
• Dmg Orthopedics Mri Of Rotator Cuff Tear Image
• Rotator Cuff Mri Tear
• Dmg Orthopedics Mri Of Rotator Cuff Tear Arthropathy
• Dmg Orthopedics Mri Of Rotator Cuff Tear Icd 10

Feb 05, 2007  MRI changes in the rotator cuff and tendinitis have been correlated with findings from conventional double‐contrast arthrography, 5,8,20,35,23 computed arthrotomography, 5,8 arthroscopy 11,23 and histological evaluation of the rotator cuff. They help to stabilize the ball in the socket while the bigger muscles around the shoulder lift the arm overhead, out away from the body and behind the back. A doctor can examine your shoulder to detect weakness of the rotator cuff. After x-rays, the surgeon could get an MRI to show a tear of one or more of the rotator cuff tendons. Also read: Rotator cuff tears. To find out if you have a torn rotator cuff, your doctor will start with a history of the injury and a physical examination of the shoulder. During the exam, your doctor will check your range of motio. Nov 16, 2018  The shoulder is a complex joint with multiple tendons and muscles surrounding it. Diagnosis of muscle and tendon tears within the shoulder requires tests that allow visualization inside the joint. Arthrograms and MRI scans are different tests that can. Sierra dmg files won t open.

Summary

Background

Shoulder joint is a common site of musculoskeletal pain caused, among other things, by rotator cuff tears due to narrowing of subacromial space, acute trauma or chronic shoulder overload. Magnetic resonance imaging (MRI) is an excellent modality for imaging of soft tissues of the shoulder joint considering a possibility of multiplanar image acquisition and non-invasive nature of the study. The aim of this study was to evaluate the prevalence of partial and complete rotator cuff tears in magnetic resonance images of patients with shoulder impingement syndrome and to review the literature on the causes and classification of rotator cuff tears.

Material/Methods

We retrospectively analyzed the results of 137 shoulder MRI examinations performed in 57 women and 72 men in Magnetic Resonance facility of the Department of Radiology and Diagnostic Imaging at the St. Jadwiga the Queen Regional Hospital No. 2 in Rzeszow between June 2010 and February 2013.

Examinations were performed using Philips Achieva 1.5T device, including spin echo and gradient echo sequences with T1-, T2- and PD-weighted as well as fat saturation sequences in transverse, frontal and sagittal oblique planes.

Patients were referred from hospital wards as well as from outpatient clinics of the subcarpathian province.

Results

The most frequently reported injuries included partial supraspinatus tendon tear and complete tearing most commonly involved the supraspinatus muscle tendon.

The smallest group comprised patients with complete tear of subscapularis muscle tendon.

Among 137 patients in the study population, 129 patients suffered from shoulder pain, including 57 patients who reported a history of trauma. There was 44% women and 56% men in a group of patients with shoulder pain. Posttraumatic shoulder pain was predominantly reported by men, while women comprised a larger group of patients with shoulder pain not preceded by injury.

Conclusions

Rotator cuff injury is a very common pathology in patients with shoulder impingement syndrome. Isolated supraspinatus tendon injury or complete tearing is most frequent, rather than in conjunction with injuries to other rotator cuff tendons. We did not observe isolated complete tears of infraspinatus and subscapular muscle tendons.

Background

Shoulder joint is the third most common site of musculoskeletal pain occurring in 7–26% of general population []. Males over 40 years old are affected most often [2]. Pathological changes to rotator cuff are frequently the cause [3]. They develop as a result of chronic impingement syndrome, acute injury, chronic overload or supraspinatus muscle ischemia [2].

Dmg Orthopedics Mri Of Rotator Cuff Tear Symptoms

Flat tendons of four muscles: supraspinatus, infraspinatus, subscapularis and teres minor constitute the rotator cuff. They join together, covering anterior, posterior and superior surface of acromioscapular joint like a shirtsleeve. It enables shoulder rotation, hence the name “rotator cuff.”

Moreover, their primary function involves maintaining shoulder stability during arm movement [4] and holding humeral head within glenoid cavity. Subacromial bursa, located between humeral head and acromion, reduces friction between muscles and acromion during arm movements, particularly in abduction [5].

Most common causes of rotator cuff injury include:

• 1. Repeated throwing or arm waving (volleyball, tennis, baseball, swimming, handball or strength training) in active, young people [5];

• 2. Impingement syndrome [2] – reduction of space between acromion and humeral head. Rotator cuff and its corresponding bursa may become constricted during arm lifting, which leads to inflammation and edema of the tendon and the bursa, resulting in pain.

Articular capsule and subacromial bursa are highly innervated and compression of those structures together with bursitis are considered the main source of pain [].

It might result from anatomical variations of acromion (rotator cuff tear accompanies type III acromion according to Bigliani classification in 80% of cases) [2], acromioclavicular osteoarthritis with osteophyte formation [2] (osteophytes larger than 3 mm pointed downward are of significance []), chronic subacromial bursitis [2] (minute amount of fluid in the bursa is a frequent finding, more than 3 mm of fluid is considered exudate suggestive of bursitis []), posttraumatic deformation of humeral head and os acromiale [2]. It might also result from abnormal reduction of space between coracoid process and humeral head [2].

• 3. Trauma – fall onto an arm, particularly in the elderly;

• 4. Age – related degeneration of rotator cuff tendons [2], which are more susceptible to injury due to decreased blood flow [2,7].

Clinical signs of injury include pain in superior part of the arm (mostly anteriorly and laterally) becoming more intense during arm movements – so-called painful arc (i.e. pain on abduction between 70 and 120 degrees), waking up at night [5] or not allowing to sleep, especially when patient is lying on the affected side, weakening of arm strength, limited arm movement (e.g. difficulty in fastening a bra, putting the affected hand into a back pocket, combing hair), cracking noises during arm movements [5], disruption of so-called scapulohumeral rhythm.

There are many classifications that characterize rotator cuff injuries.

Neer described three stages of injury to rotator cuff tendons:

• Stage I – edema/bleeding usually occurs in people under 25 years old who actively participate in sports activities, particularly in disciplines that require arm lifting (e.g. swimming). It is entirely treatable with conservative management [3,8,9].

• Stage II – fibrosis-tendinitis usually occurs in patients between 25 and 40 years old. There is thickening and fibrosis of subacromial soft tissues. This condition presents clinically as recurrent shoulder pain [3,8,9]. Management is conservative as in stage I. However, persistence of symptoms over 6–12 months despite conservative treatment justifies surgical intervention [8].

• Stage III – tendon tear leading to progressive failure of limb motor function. It is most common in patients over 40 years old [3,8,9]. Surgical treatment depends on patient age, loss of limb function, presence of limb weakness and pain [3].

Ellman et al. divided complete rotator cuff injuries into small (less than 1 cm), moderate (1–3 cm), large (3–5 cm), and massive (>5cm).

Snyder classified rotator cuff injuries as [10]:

• 0: normal;

• I: minimal irritation of bursa or synovial membrane or mild damage to articular capsule involving small surface (<1 cm);

• II: damage and loss of some rotator cuff fibers, as well as damage to bursa or capsule (<2 cm);

• III: damage and fragmentation of tendon fibers, usually involving entire thickness of a tendon, usually of the supraspinatus muscle (<3 cm);

• IV: severe damage accompanied by tendon tear and fragmentation often involving more than one tendon.

SCOI classification (Snyder) divides rotator cuff injuries into [11]:

1. partial periarticular tear;

2. partial peribursal tear;

3. complete tear.

Partial periarticular tears are more common than peribursal [10] and twice as common as complete tears [2,10].

Periarticular tears most often result from degeneration caused by chronic overload [2].

Partial peribursal tears (incomplete thickness) are most frequently related to impingement syndrome [2,10].

In 95% of cases rotator cuff pathology involves supraspinatus muscle tendon (alone or together with the remaining rotator cuff muscles) [].

Due to its non-invasiveness, MR imaging supersedes shoulder artrography. Its superiority lies in the fact that it allows visualization of both bone and periarticular soft tissues in frontal, axial and sagittal oblique planes [9].

The goal of this work was to assess frequency of occurrence of partial and complete rotator cuff muscle tears in magnetic resonance imaging among patients with painful shoulder syndrome as well as to review literature on the causes of rotator cuff injuries and their classifications.

Material and Methods

Retrospective analysis was performed on the results of 137 shoulder MRI examinations, including 57 women and 72 men, performed in Magnetic Resonance facility of the St. Jadwiga the Queen Provincial Hospital in Rzeszow between June 2010 and February 2013.

The largest group consisted of patients aged 40–65 years – 52% of subjects, while patients from the age group of 25–40 years constituted 18.6% of studied population, people over 65 years old – 10% of subjects. Patients between 5 and 25 years old comprised the smallest studied age group corresponding to 9.3% of studied population.

Patients were referred for examinations from hospital wards and specialist outpatient clinics of subcarpathian province.

Images were acquired with a 1.5T Achieva Phillips device in T1- T2- and PD-weighted spin echo and gradient echo sequences and partly in fat saturation sequences in transverse, frontal and sagittal oblique planes.

Results

In our study group 129 patients reported shoulder pain, including 44% of subjects with a history of trauma.

A group of patients reporting pain comprised of women in 44% and of men in 56%. Posttraumatic shoulder pain was predominantly reported by men (32% of subjects), while a larger group of patients with shoulder pain without history of trauma consisted mainly of women (32% of subjects) (Table 1).

Table 1

Types of diagnosed rotator cuff tendon injuries are presented in Table 2.

Table 2

Most commonly occurring pathologies included partial tear (edema, fibrosis and tearing of some fibers) of supraspinatus muscle tendon (57%), followed by subscapularis muscle tendon (31%) and, less frequently, infraspinatus tendon tears (26%).

Complete tearing usually involved the supraspinatus muscle tendon – 11% (Figure 1), more rarely infraspinatus muscle (2%) and subscapularis muscle (0.7%) tendons. The least numerous group comprised of patients with complete subscapularis muscle tendon tear – 0.7%.

Shoulder MRI. (A) T2-weighted image, frontal plane. Complete tear of supraspinatus tendon with retraction of the torn edge and muscle atrophy (arrow). (B) T2-weighted image, frontal plane. Narrowing of subacromial space (star). Acromioclavicular joint arthrosis (arrow). Increased volume of intraarticular fluid. Subacromial-subdeltoid bursa fluid.

Among partial tears the most frequent pathology involved isolated supraspinatus tendon injury amounting to 32.5% of patients (Figure 2).

Shoulder MRI. (A) T1-weighted image, frontal plane. (B) T2-weighted image, frontal plane. Anterior supraspinatus tendon thinning, partial tear above the attachment to greater tubercle (arrow). Posttraumatic changes of lesser and greater tubercles, bone marrow (star) and surrounding soft tissue edema. (C) T2-weighted image, frontal plane. Increased volume of intraarticular fluid (arrow head).

Partial tearing of two muscle tendons was diagnosed in 26% of subjects (including supraspinatus and infraspinatus tendons in 12%, supraspinatus and subscapularis tendons in 14% (Figure 3)). We did not observe any cases of partial injury to infraspinatus and subscapularis muscle tendons without supraspinatus tendon tear.

Shoulder MRI. (A) T1-weighted image, frontal plane. (B) T1-weighted image, transverse plane. Supraspinatus tendon tear (arrow) T1-weighted image, transverse plane. Subscapularis tendon tear (arrow).

Partial supraspinatus, infraspinatus and subscapularis muscle tendon tears were identified in 8% of subjects.

Complete tearing usually involved the supraspinatus muscle tendon in conjunction with partial tearing of infraspinatus and subscapularis tendons – 5.4% of subjects (Figure 4), followed by complete supraspinatus muscle tendon tear without concomitant injury to other muscle tendons in 2.3% of cases. Isolated complete subscapularis or infraspinatus tendon tears were not observed.

Shoulder MRI. (A) T2-weighted image, frontal plane. Complete supraspinatus tear (arrow) with muscle partial retraction. Increased volume of subacromial-subdeltoid bursa fluid. (B) T1-weighted image, transverse plane. Partial tear (star) of subscapularis (arrow) and infraspinatus tendons (star).

In our study group complete tearing of supraspinatus and infraspinatus muscle tendons, complete tearing of supraspinatus and subscapularis tendons, complete tearing of infraspinatus muscle tendon + partial supraspinatus tendon tear, complete supraspinatus and infraspinatus tendon tears + partial subscapular tendon tear (Figure 5) and complete supraspinatus tendon tear + partial infraspinatus muscle tendon tear occurred in 0.8% of patients (one patient each).

(A) T2-weighted image, frontal plane. Complete supraspinatus tendon tear with muscle atrophy (arrow). (B) T1-weighted image, transverse plane. Complete infraspinatus tendon tear with muscle atrophy (arrow). Partial subscapularis tendon tear (star). (C) T1-weighted image, frontal plane. Narrowing of subacromial space (arrow). Acromioclavicular joint arthrosis (star).

None of our patients presented with complete tearing of all three muscle tendons (Table 3).

Table 3

Types of damage to rotator cuff tendons in the study population.

Discussion

Shoulder MRI examination is a valuable method of assessment of rotator cuff pathologies. Morrison and Offstein analyzed artrography and MRI examinations of 100 patients with chronic impingement syndrome. It was shown that MRI was 100% sensitive but only 88% specific for rotator cuff injuries confirmed by artrography [3]. Other authors report 75–92% sensitivity and 84–94% specificity of this examination in cases of complete rotator cuff tears. Moreover, there was a full concordance regarding the size of tear reported in MRI and measurements obtained during surgery [9].

Despite the special character of MRI examination it should be always preceded by plain radiograms directed at identification of soft tissue calcifications, appearance of which varies in MRI. Ultrasonography may constitute an alternative to MRI in rotator cuff assessment, although its sensitivity depends largely on the experience of the examiner [2].

Among analyzed shoulder MRI examinations rotator cuff injury was diagnosed in 106 (82%) patients, including 100 (94%) patients with isolated supraspinatus tendon injury or together with the remaining rotator cuff muscles, which is concordant with literature data indicating that supraspinatus muscle tendon is damaged in 95% of rotator cuff pathologies [].

Literature data indicate that partial tendon tear is more common than complete tear [10], as confirmed by our study, which showed partial supraspinatus tendon tear in 86 (81%) subjects with diagnosed rotator cuff pathology, while complete tear was diagnosed in 11 (10%) patients. The same applies to infraspinatus muscle tendon (where complete tear occurred in 34 patients, while three patients suffered complete tear) and subscapularis muscle tendon (where 40 patients were diagnosed with partial tear and only one with complete tear).

Among all patients with rotator cuff tendon pathology included in our study 58 (55%) patients were diagnosed with acromioclavicular osteoarthritis (from minute to advanced lesions), which is concordant with literature data indicating it as one of the causes of rotator cuff injury [2].

One should remember that painful shoulder syndrome might result from joint, muscle, tendon or articular capsule pathology, while not always being related to rotator cuff tendon injuries.

Conclusions

1. Rotator cuff tendon pathology was very often diagnosed in the study group of patients with shoulder pain. In men it was most often caused by trauma, while in women it was more frequently non-traumatic.

2. Injury usually involved supraspinatus muscle tendon alone, rarely together with other rotator cuff muscle.

3. Supraspinatus muscle tendon tear was the most commonly identified pathology, more rarely subscapularis muscle and infraspinatus muscle tendon injuries.

4. Complete tear most often involved supraspinatus muscle tendon (also as an isolated lesion) followed by infraspinatus and, least often, subscapularis muscle tendons.

5. None of the patients presented with complete tear of all three rotator cuff muscle tendons or isolated infraspinatus or subscapularis tendon tears.

References

Abstract

Objective

To determine the interobserver and intraobserver reliability of the interpretation of MRIs for supraspinatus tendinosis.

Methods

In the interobserver trial, the MRIs of 52 athletes' shoulders were observed by 3 observers on one occasion within a 2‐month period. All 52 images were read by the most experienced musculoskeletal radiologist on 3 different occasions on separate days without access to the previous readings for the intraobserver trial. Supraspinatus tendinosis was graded using a modified 4‐point scale from grades 0 to grade 3.

Results

The grading of MRI‐determined supraspinatus tendinosis was reliable, having an intraclass correlation (ICC) of 0.85 when assessed by the single well‐trained observer. Interobserver reliability was only fair to good (ICC = 0.55).

Conclusions

Supraspinatus tendinosis can be accurately identified on MRI with little variation by a single well‐trained observer. Interobserver reliability was only fair to good. Our data indicated that the reliability of the assessment was much greater in more experienced radiologists than in those with less experience.

MRI has proven to be useful in the assessment of rotator cuff injuries. MRI is a non‐invasive method of imaging and is unique in that it allows the differentiation of soft tissue structures. Improvements in MRI techniques, including fast spin‐echo imaging and fat saturation, have facilitated demonstration of tendinous abnormalities of the rotator cuff.

The MRI findings of rotator cuff tendinopathy are characterised by thickened inhomogeneous rotator cuff tendon with increased signal intensity on all pulse sequences.² Fluid intensity filling an incomplete gap in the tendon on fat‐suppressed T2‐weighted sequences changes are seen on MRI for partial‐thickness tears. On MRI, an area of high signal intensity on all pulse sequences outlines complete disruption of the tendon.

MRI is a non‐invasive technique for investigating lesions of the rotator cuff.^,,,,,, It is widely used in clinical practice to investigate shoulder problems in patients, particularly those relating to the rotator cuff and to glenohumeral joint instability. Advances in technology have greatly improved the quality of MRI.

Many studies have demonstrated acceptable levels of sensitivity, specificity and accuracy in the diagnosis of cuff and capsulo‐labral pathology.^,,,,, The reliability of assessing supraspinatus tendinopathy has not been determined.

Materials and methods

Subjects

Under ethical approval from the SouthEast Health Human Research Ethics Committee (Sydney, Australia), 52 elite swimmers, of club to international levels, participated in the MRI reliability study. The group consisted of 28 (54%) males and 24 (46%) females. They were aged between 13 and 25 years, with a mean (SD) age of 15.5 (2.7) years and a median age of 16 years. The swimmers underwent an MRI of a single shoulder: either the dominant shoulder if asymptomatic or the most affected shoulder if symptomatic. Each swimmer's evaluation included a shoulder pain and function examination and a swimming training profile before the MRI. Swimmers were excluded if they had any previous surgery, fracture of the shoulder, or inability or unwillingness to participate in the MRI and clinical shoulder examinations. Each participant of the study was given an information sheet outlining the MRI investigation and a consent form to complete.

Study design

One observer made three readings of the same MRIs (intraobserver trial) and three observers independently made readings on the same set of images (interobserver trial).

MRI unit

Oblique coronal proton density (PD) and fat‐suppressed T2, sagittal T2 and axial PD sequencing were performed on a Signa 1.5 T superconducting magnet, Hi Speed MRI unit (General Electric Medical Systems, Milwaukee, Wisconsin, USA), using system software V.9.1, slew rate 77 T/m/s, 33 mm T gradient amplitude, utilising a high resolution, non‐arthrographic technique with a four‐channel phased array shoulder coil (Medical Advances, Milwaukee, Wisconsin, USA). Table 1​1 outlines the MRI protocol used in this study.

FOV, field of view; NEX, number of excitations; TE (eff), echo time (effective); TR, repetition time.

Supraspinatus tendinosis grading

Tendinopathy is characterised by an increased intrasubstance signal on short TE sequences that is not as bright as the fluid on T2‐weighted images. The involved tendons may be of a normal calibre or thickened. Differentiating tendinosis with a morphologically normal tendon from the magic angle phenomenon is facilitated by signal alteration that persists on long TE images in tendinopathy. In this study, supraspinatus tendinosis was graded using a modified 4‐point scale from 0 to 3 based on previous studies.^,,,

Diagnosis was based on the appearance of the rotator cuff tendons (grading system) and the presence or absence of signs denoting involvement of the subacromial bursa and subacromial–subdeltoid plane.^,

In our study, grade 0 (normal) was a tendon with complete homogeneous low intensity on all pulse sequences or minor intratendon signal hyperintensity consistent with magic angle artefact (fig 1​1 A), grade 1 (mild tendinosis) mild focal increase in tendon signal on PD and fat‐suppressed T₂ sequencing not equal to that of fluid (fig 1​1 B), grade 2 (moderate tendinosis) moderate focal increase in tendon signal on PD and fat‐suppressed T₂ sequencing not equal to that of fluid (fig 1​1 C), and grade 3 (marked tendinosis) marked a generalised increase in tendon signal without frank fluid signal intensity (fig 1​1 D). Mtg deal three dmg to each creature.

Figure 1 MRIs of the shoulder illustrating tendinosis grading. (A) Grade 0 (normal). A tendon with complete homogeneous low intensity on all pulse sequences or minor intratendon signal hyperintensity consistent with magic angle artefact. (B) Grade 1 (mild tendinosis). Mild focal increase in tendon signal on PD and fat‐suppressed T₂ sequencing not equal to that of fluid. (C) Grade 2 (moderate tendinosis). Moderate focal increase in tendon signal on PD and fat suppressed T₂ sequencing not equal to that of fluid. (D) Grade 3 (marked tendinosis). Marked generalised increase in tendon signal without frank fluid signal intensity.

Interobserver reliability trial

Three musculoskeletal radiologists received for the interobserver reliability trial. The experience levels of the three musculoskeletal radiologists varied. The first radiologist had 9 years of experience in musculoskeletal MRI. The second radiologist had a 1‐year training fellowship and 1 year in the clinical practice of MRI reading. The third musculoskeletal radiologist had much less experience in MRI reading. For each swimmer, the three musculoskeletal radiologists (ie, observers) recorded their supraspinatus tendinosis grade using the standardised criteria (fig 1A–D).

All three observers were blinded to the identity of the swimmers, and each of them read all 52 images on one occasion. Before the reading, each observer was briefed on the study protocol by the most experienced radiologist and given the criteria for grading, together with the MRI forms for the supraspinatus tendinosis reliability test. The readings were performed within 2 months of each other.

Intraobserver reliability trial

The intraobserver reliability trial was based on the same 52 swimmers. The most experienced musculoskeletal radiologist read all 52 images on 3 different occasions without access to the previous readings.

Statistical analysis

Intraobserver reliability and intraobserver reliability trails were analysed for their intraclass correlation coefficients (ICCs) with SPSS, using a 2‐way random‐effects model with absolute agreement (2, 1). According to Fleiss^21,22, an ICC value <0.4 represents poor reliability, values >0.75 represent excellent reliability and values between 0.4 and 0.75 represent fair to good reliability (194–196).

Results

Incidence of tendinosis

Of the 52 shoulders examined, 69% (25 male, 11 female) had MRI‐assessed tendinosis, 27 (52%) grade 1, 8 (15%) grade 2 and 1 (2%) grade 3.

Clinical relevance

Some authors have identified abnormal signal intensity of the supraspinatus tendon^{,,,,,,,,,,,,,} of asymptomatic individuals. Of the elite swimmers in our study, 36/52 (69%) had MRI‐determined supraspinatus tendinosis. Each of these swimmers had a positive impingement sign. The positive impingement sign correlated significantly with the MRI assessment of tendinosis (r = 0.49, p<0.001).

Reliability of the supraspinatus tendinosis grading

Interobserver reliability trial

Figure 2​2 shows the interobserver ICC for the three observers' readings for the MRI‐determined supraspinatus tendinosis grading. Interobserver reliability of the readings for MRI‐determined supraspinatus tendinosis grading had an ICC = 0.55, with a 95% CI ranging from 0.27 to 0.72. According to Fleiss,^21,22 this level of agreement between the three radiologists is rated as fair to good.

Figure 2 Interobserver reliability of supraspinatus tendinosis grading.

Intraobserver reliability trial

Figure 3​3 shows the intraobserver ICC for three readings. Intraobserver reliability of readings of the MRI‐determined supraspinatus tendinosis grading was ICC = 0.85, with the 95% CI between 0.72 and 0.9. On the basis of the criteria of Fleiss,^21,22 this level of agreement between the three readings is rated as excellent.

Figure 3 Intraobserver reliability of supraspinatus tendinosis grading.

Discussion

In elite swimmers, supraspinatus tendinopathy is one of the main causes of shoulder pain. Improvements in MRI, including fast spin‐echo imaging and fat saturation, have facilitated demonstration of tendinous abnormalities of the rotator cuff. MRI changes in the rotator cuff and tendinitis have been correlated with findings from conventional double‐contrast arthrography,^,,,, computed arthrotomography,^, arthroscopy^, and histological evaluation of the rotator cuff.

Supraspinatus tendinopathy can be detected using MRI. Kjellin et al compared MRIs and histological analysis on cadaver shoulders and showed that increased signal intensity on PD‐weighted images (without further increased signal intensity on T2‐weighted images) and an indistinct margin at the articular side of the supraspinatus tendon corresponded to eosinophilic, fibrillar, and mucoid degeneration and scarring. Areas of increased signal intensity on T2‐weighted images were associated with severe degeneration and disruption of the supraspinatus tendon. A study by Gagey et al and Williams et al also found that gross anatomical and MRI abnormalities of the rotator cuff corresponded to histological changes consistent with tendon degeneration. We observed an excellent correlation between MRI‐determined tendinopathy and a positive impingement sign in swimmers.

The sensitivity and specificity of magnetic resonance scanning in the diagnosis of partial‐thickness and full‐thickness defects of the rotator cuff have been well documented.^,, We found that the grading of MRI‐determined supraspinatus tendinosis grading was reliable (ICC = 0.85) when assessed by a single well‐trained observer. However, the interobserver reliability was only fair to good (ICC = 0.55). Our data indicated that the reliability of the assessment was much greater in more experienced radiologists and less in the junior radiologist.

What is already known on this topic

• MRI is a useful, non‐invasive technique for the assessment of shoulder problems, particularly those relating to the rotator cuff and glenohumeral joint instability. The reliability of assessing supraspinatus tendinopathy using MRI, however, has not been determined.

What this study adds

• In elite swimmers, supraspinatus tendinopathy is one of the main causes of shoulder pain.

• This study found MRI assessment of tendinopathy to be reliable with a single well‐trained observer and less so with other observers.

• There was an excellent correlation between MRI‐determined tendinopathy and a positive impingement sign in swimmers.

Acknowledgements

This study was supported by St George Hospital/South East Sydney and Illawarra Area Health Service. We thank the New South Wales Institute of Sport, its coaches, swimmers and their parents for their enthusiastic participation, and the Castlereagh Imaging group for their expertise in MRI interpretation.

Abbreviations

Footnotes

References

Mri For Determining Rotator Cuff Tear

Dmg Orthopedics Mri Of Rotator Cuff Tear Image

Rotator Cuff Mri Tear

Dmg Orthopedics Mri Of Rotator Cuff Tear Arthropathy

Dmg Orthopedics Mri Of Rotator Cuff Tear Icd 10