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ARTICLE
REVIEW: From: Miniaci A. Am J Sports Med. 1995; 2:142-145. Submitted by: WARREN JAHN, DC, FACO Synopsis This study discusses the findings of magnetic resonance imaging in twenty asymptomatic volunteers. Thirty shoulders were studied. The average age was twenty-nine years; the youngest subject was seventeen and the oldest forty-nine. The authors used a four point grading scale in order to classify the images: Grade 0: was a normal tendon with a low intensity, homogenous structure. Grade 1: was a focal, linear, or diffuse intermediate signal through the tendon. Grade 2: was a high signal intensity within the tendon and through less than the full thickness.Grade 3: was a high signal intensity through the full thickness of the tendon. NONE of the supraspinatus or infraspinatus tendons were NORMAL ( grade 0 ). ALL tendons had grade 1 signals through the tendons. Seven of the thirty tendons (23%) had grade 2 signals. However, none had grade 3 changes. Conclusion The authors concluded that non-enhanced magnetic resonance imaging MAY BE OF LIMITED VALUE in defining rotator cuff injury in a patient with shoulder pain unless a full thickness rotator cuff tear is suspected clinically. AAOM comment: …Need we say more? It is obvious from this study that a non-enhanced MRI has little benefit in the clinical diagnosis of rotator cuff tendopathies. The findings above, together with the increasing body of literature concerning the innervation of the subacromial bursa,1,2 confirms our belief that the bursa is often the site of the nociceptive afference (pain). Soider et al. claim that the bursa has the highest innervation density of all the subacromial structures.3 The cause of the inflammation is usually direct impingement. (There are several causes of impingement, but further discussion in this regard would take us too far away from discussing the clinical implications of the above study.) Thus, our subjective clinical paradigm remains that when a resisted test for the cuff causes less pain when re-tested with simultaneous pull on the humerus, (which allows for a decrease in the superior movement of humerus due to deltoid pull), at least a bursal irritation can be suspected…regardless of the objective MRI findings. Monu et al. conclude that in their symptomatic population group of twenty one patients, isolated subacromial bursal fluid was very likely to be associated with the finding of other abnormalities in the shoulder at surgery: rotator cuff impingement (43%), glenoid labrum abnormalities (29%), bursitis (19%), and supraspinatus tendinitis (14%).4 References 1. Aszmann OC, Dellon AL,Birely BT, McFarland EG. Innervation of the human shoulder joint and its implications for surgery. Clin Orthop. 1996;330:202-207 2. Vangsness CT Jr, Ennis M, Taylor JG, Atkinson R. Neural anatomy of the glenohumeral ligaments, labrum, and subacromial bursa. Arthroscopy. 1995;11:180-184 3. Soider TB, Levy HJ, Soifer FM, Kleinbart F, Vigorita V, Bryk E. Neurohistology of the subacromial space. Arthroscopy. 1996;12:182-186 4. Monu JU, Pruett S, Vanarthos WJ, Pope TL Jr. Isolated subacromial bursal fluid on MRI of the shoulder in symptomatic patients: correlation with arthroscopic findings. Skeletal Radiol. 1994;23:529-533 Warren T. Jahn, DC, MPS,
FACO, DACBSP, DABFP
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