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Sonography of Full-Thickness Supraspinatus Tears: Comparison of Patient Positioning Technique with Surgical Correlation

Melanie Ferri1, Karen Finlay2, Terry Popowich3, Gary Stamp4, Peter Schuringa5 and Lawrence Friedman2

1 Department of Diagnostic Imaging, McMaster University and Hamilton Health Sciences, 1003-81 Charlton Ave. E, Hamilton, ON, Canada, L8N 1Y7.
2 Department of Diagnostic Imaging, McMaster University and Hamilton Health Sciences, Henderson General Hospital, 711 Concession St., Hamilton, ON, Canada L8V 1C3.
3 Department of Diagnostic Imaging, St. Joseph's Hospital, 50 Charlton Ave. E, Hamilton, ON, Canada L8N 4A6.
4 Department of Orthopaedic Surgery, Guelph General Hospital, 115 Delhi St., Guelph, ON, Canada N1E 4J4.
5 Department of Orthopaedic Surgery, St. Mary's Hospital, 911 Queen's Blvd., Kitchener, ON, Canada N2M 1B2.



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  		Fig. 1A. —Photographs of open surgical repair of supraspinatus tendon in 48-year-old man. Supraspinatus tendon is exposed.

 


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  		Fig. 1B. —Photographs of open surgical repair of supraspinatus tendon in 48-year-old man. Tear is measured in transverse plane with linear sterile ruler.

 


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  		Fig. 2A. —Arthroscopic measurement in 36-year-old man. Photographs show measurement of supraspinatus tear in transverse plane using surgical instrument of known length.

 


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  		Fig. 2B. —Arthroscopic measurement in 36-year-old man. Photographs show measurement of supraspinatus tear in transverse plane using surgical instrument of known length.

 


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  		Fig. 3A. —Transverse measurements of full-thickness tear of supraspinatus tendon (arrows) in 39-year-old man. Sonograms show measurement in Crass (A) and modified Crass (B positions.

 


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  		Fig. 3B. —Transverse measurements of full-thickness tear of supraspinatus tendon (arrows) in 39-year-old man. Sonograms show measurement in Crass (A) and modified Crass (B positions.

 


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  		Fig. 4A. —Sagittal measurements of full-thickness tear of supraspinatus tendon (arrows) in 39-year-old man. Sonograms show measurement in Crass (A) and modified Crass (B positions.

 


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  		Fig. 4A. —Sagittal measurements of full-thickness tear of supraspinatus tendon (arrows) in 39-year-old man. Sonograms show measurement in Crass (A) and modified Crass (B positions.

 


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  		Fig. 5A. —Axial proton density-weighted fat-saturated MR images of shoulder in 28-year-old woman. MR images show shoulder in neutral anatomic position (A), Crass position (B), and modified Crass position (C). Note supraspinatus tendon (arrow) moves from lateral position in neutral to anterior in Crass position and anterolateral in modified Crass position, which affords better sonographic visualization in Crass and modified Crass positions.

 


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  		Fig. 5B. —Axial proton density-weighted fat-saturated MR images of shoulder in 28-year-old woman. MR images show shoulder in neutral anatomic position (A), Crass position (B), and modified Crass position (C). Note supraspinatus tendon (arrow) moves from lateral position in neutral to anterior in Crass position and anterolateral in modified Crass position, which affords better sonographic visualization in Crass and modified Crass positions.

 


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  		Fig. 5C. —Axial proton density-weighted fat-saturated MR images of shoulder in 28-year-old woman. MR images show shoulder in neutral anatomic position (A), Crass position (B), and modified Crass position (C). Note supraspinatus tendon (arrow) moves from lateral position in neutral to anterior in Crass position and anterolateral in modified Crass position, which affords better sonographic visualization in Crass and modified Crass positions.

 


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  		Fig. 6A. —Sagittal oblique proton density-weighted fat-saturated MR images of shoulder in 28-year-old woman. MR images show supraspinatus tendon (arrows) beneath acromion located in neutral position (A), anteriorly in Crass position (B), and anterolaterally in modified Crass position (C).

 


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  		Fig. 6B. —Sagittal oblique proton density-weighted fat-saturated MR images of shoulder in 28-year-old woman. MR images show supraspinatus tendon (arrows) beneath acromion located in neutral position (A), anteriorly in Crass position (B), and anterolaterally in modified Crass position (C).

 


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  		Fig. 6C. —Sagittal oblique proton density-weighted fat-saturated MR images of shoulder in 28-year-old woman. MR images show supraspinatus tendon (arrows) beneath acromion located in neutral position (A), anteriorly in Crass position (B), and anterolaterally in modified Crass position (C).

 


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  		Fig. 7A. —Crass and modified Crass positions. Photographs show Crass (A) and modified Crass (B) positions. Note that sonographic probe is moved from anterior to anterolateral position, corresponding to altered position of supraspinatus tendon.

 


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  		Fig. 7B. —Crass and modified Crass positions. Photographs show Crass (A) and modified Crass (B) positions. Note that sonographic probe is moved from anterior to anterolateral position, corresponding to altered position of supraspinatus tendon.

 

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