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Rotator Cuff Impingement: Correlation Between Findings on MRI and Outcome After Fluoroscopically Guided Subacromial Bursography and Steroid Injection

¹ Department of Radiology, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland.
² Department of Radiology, Cappagh National Orthopaedic Hospitals, Dublin, Ireland.
³ School of Public Health and Population Science, University College Dublin, Dublin, Ireland.

View larger version (58K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —MRI findings of impingement. A = acromion, Cl = clavicle, B = subacromial bursa, Su = supraspinatus muscle, H = proximal portion of humerus. Diagram shows inferiorly oriented osteophyte producing impingement (arrow).

View larger version (60K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —MRI findings of impingement. A = acromion, Cl = clavicle, B = subacromial bursa, Su = supraspinatus muscle, H = proximal portion of humerus. Diagram shows hooked acromion causing impingement (arrow).

View larger version (59K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —MRI findings of impingement. A = acromion, Cl = clavicle, B = subacromial bursa, Su = supraspinatus muscle, H = proximal portion of humerus. Diagram shows inferiorly oriented osteophyte with associated full-thickness tear (arrow) of supraspinatus tendon.

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —30-year-old man with grade 1 findings of isolated subacromial bursitis and symptom duration of 1 month who reported complete resolution of symptoms after fluoroscopically guided subacromial steroid injection. Subacromial bursogram shows isolated subacromial bursitis.

View larger version (179K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —30-year-old man with grade 1 findings of isolated subacromial bursitis and symptom duration of 1 month who reported complete resolution of symptoms after fluoroscopically guided subacromial steroid injection. Coronal oblique STIR MR image (TR/TE, 2,000/20; inversion time, 160 milliseconds; echo-train length, 8) shows isolated subacromial bursitis (arrow).

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —46-year-old woman with inflammatory changes in acromioclavicular joint with osteophyte formation, secondary impingement, and bursitis (grade 2). Symptom duration was 4 months, and patient reported complete resolution of symptoms after 6 months of follow-up. Subacromial bursogram shows inflammatory changes in acromioclavicular joint.

View larger version (169K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —46-year-old woman with inflammatory changes in acromioclavicular joint with osteophyte formation, secondary impingement, and bursitis (grade 2). Symptom duration was 4 months, and patient reported complete resolution of symptoms after 6 months of follow-up. Coronal oblique STIR MR image (TR/TE, 2,000/20; inversion time, 160 milliseconds; echo-train length, 8) shows changes in acromioclavicular joint (open arrow) with osteophyte formation (closed arrow).

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —56-year-old man with hypertrophic inflammatory change in acromioclavicular joint with secondary impingement and tendinopathy and partial-thickness tear at insertion of supraspinatus tendon (grade 4). Symptom duration was 8 months. After injection, patient reported initial complete resolution of symptoms lasting 4 weeks with gradual return of symptoms. At 6-month follow-up evaluation, symptoms had not returned to baseline, and patient reported improvement in activities of daily living. Outcome was classified partial response to treatment. Subacromial bursogram shows partial-thickness tear at insertion of supraspinatus tendon.

View larger version (180K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —56-year-old man with hypertrophic inflammatory change in acromioclavicular joint with secondary impingement and tendinopathy and partial-thickness tear at insertion of supraspinatus tendon (grade 4). Symptom duration was 8 months. After injection, patient reported initial complete resolution of symptoms lasting 4 weeks with gradual return of symptoms. At 6-month follow-up evaluation, symptoms had not returned to baseline, and patient reported improvement in activities of daily living. Outcome was classified partial response to treatment. Coronal oblique STIR MR image (TR/TE, 2,000/20; inversion time, 160 milliseconds; echo-train length, 8) shows partial-thickness tear (arrow) at insertion of supraspinatus tendon.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —68-year-old woman with full-thickness tear of rotator cuff (grade 5). Symptom duration was more than 2 years. Patient reported initial resolution of symptoms lasting 10 days but gradual return of symptoms to baseline. Outcome was classified no change after 6 months of follow-up. Subacromial bursogram shows free communication of contrast medium (arrow) between subacromial space and glenohumeral joint.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —68-year-old woman with full-thickness tear of rotator cuff (grade 5). Symptom duration was more than 2 years. Patient reported initial resolution of symptoms lasting 10 days but gradual return of symptoms to baseline. Outcome was classified no change after 6 months of follow-up. T2-weighted coronal oblique fast spin-echo MR image (TR/TEeff, 3,000/80; echo-train length, 12) corresponding to A.

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