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DOI:10.2214/AJR.04.1723
AJR 2006; 186:454-459
© American Roentgen Ray Society

Original Research

Abnormalities on MRI of the Subscapularis Tendon in the Presence of a Full-Thickness Supraspinatus Tendon Tear

Diane Bergin1, Laurence Parker1, Adam Zoga1 and William Morrison1

1 All authors: Department of Radiology, Thomas Jefferson University Hospital, 396C Main Building, 111 S 10th St., Philadelphia, PA 19107.

Received November 8, 2004; accepted after revision January 31, 2005.

 
Address correspondence to D. Bergin (diane.bergin{at}jefferson.edu).


Abstract
Top
 Abstract
Introduction
 Materials and Methods
 Results
 Discussion
 References
 
OBJECTIVE. Our objective was to determine the association between size and chronicity of full-thickness supraspinatus tendon tears with subscapularis tendon abnormalities on MRI.

MATERIALS AND METHODS. One hundred forty-two MRI examinations with full-thickness supraspinatus tendon tears were categorized on the basis of the supraspinatus muscle (SS): normal muscle (SSnormal), suggesting a recent or small tear; reduced muscle bulk without fatty atrophy (SSvolume loss); and those with fatty atrophy, suggesting a large or chronic tear (SSfatty atrophy). Subscapularis tendon abnormalities, the subcoracoid interval, and subcortical bone marrow edema in the lesser tuberosity and coracoid process were recorded.

RESULTS. The mean size of supraspinatus tendon tears in the SSnormal (n = 45) group was 8.5 mm, 16.6 mm in SSvolume loss (n = 53), and 29 mm in the SSfatty atrophy group (n = 44). Subscapularis tendon abnormality was identified in 22% of SSnormal patients, 61% of SSvolume loss, and 86% of the SSfatty atrophy group (p < 0.001). There was moderate correlation between chronicity of supraspinatus tendon tears and subscapularis tendon abnormality (r = 0.47; p < 0.0001), with no correlation between the subcoracoid interval and abnormalities of the subscapularis tendon. There was moderate correlation between chronicity of supraspinatus tendon tears and bone marrow changes in the lesser tuberosity (r = 0.44; p < 0.0001).

CONCLUSION. Subscapularis tendon abnormality is related to chronicity of supraspinatus tendon tears. Bone marrow edema in the lesser tuberosity with a subscapularis tendon abnormality suggests increased stress at the subscapularis tendon insertion with chronicity of full-thickness supraspinatus tendon tears. Lack of correlation with the subcoracoid interval indicates that anterior instability may be a more important contributing factor to subscapularis tendon abnormalities than static subcoracoid impingement in the setting of a full-thickness supraspinatus tendon tear.

Keywords: MRI • musculoskeletal imaging • shoulder • subscapularis tendon • supraspinatus tendon


Introduction
Top
 Abstract
 Introduction
Materials and Methods
 Results
 Discussion
 References
 
Tears of the rotator cuff most frequently involve the supraspinatus and infraspinatus tendons [1]. Isolated tears of the subscapularis tendon are reported to be rare and are usually associated with trauma [2]. Subscapularis tendon tears associated with tears of other rotator cuff tendons are also considered uncommon and are reported to occur in 2% of supraspinatus tendon tears [3]. Proposed causes for subscapularis tears include "extension" of supraspinatus tendon tear or subcoracoid impingement related to narrowing of the static distance between the coracoid and the lesser tuberosity [4].

In this study, we sought to determine the relationship between size and chronicity of full-thickness tears of the supraspinatus tendon with abnormalities of the subscapularis tendon. As subcoracoid impingement can be associated with subscapularis abnormalities, we also noted if objective MRI signs were seen that suggested coexistent subcoracoid impingement in this population group.


Materials and Methods
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 Abstract
 Introduction
 Materials and Methods
Results
 Discussion
 References
 
With approval from our institutional review board, we performed a database search to identify shoulder MRI examinations performed over a 12-month period with reported full-thickness supraspinatus tendon tears. One hundred forty-two shoulder MRI studies were retrospectively reviewed.

MRI studies were performed using a 1.5-T unit (Signa, GE Healthcare) with a dedicated shoulder coil, 14-cm field of view, 4-mm section thickness with a 1-mm gap, and 256 x 256 matrix. All patients were imaged in a supine position with their arm by their side, thumb pointing upward. Sequences performed were sagittal oblique T2-weighted fast spin echo (TR/effective TE, 2,500-6,000/80-90; echo-train length, 8), coronal oblique T1-weighted spin echo (400-800/8-12), coronal oblique T2-weighted fast spin echo (2,500-6,000/60-80; fat suppressed; echo-train length, 8), and axial T2-weighted fast spin echo (2,500-6,000/60-80; fat suppressed; echo-train length, 8).

Two radiologists in consensus reviewed the images. The most medial sagittal oblique T2-weighted image was used to assess supraspinatus muscle bulk relative to other rotator cuff muscles. T1-weighted coronal oblique images were used to assess muscles for fatty atrophy. MRI examinations were rated on a three-point ordinal scale: normal supraspinatus muscle (SSnormal), loss of volume of supraspinatus muscle without evidence of muscle atrophy (SSvolume loss), and muscle atrophy (SSfatty atrophy).

The anteroposterior dimension of the rotator cuff tear was measured using sagittal oblique T2-weighted images. Tears or tendonosis of the infraspinatus, teres minor, and subscapularis tendons were noted when present. Tendonosis was defined as ill-defined increased T2 signal in the tendon but less than water signal [5]. A tear was defined as discontinuity of tendon fibers with increased T2 signal in the tendon and isointense with water signal [5-7]. A full-thickness tear was defined as disruption of tendon fibers extending from the superior (bursal) to the inferior (undersurface) surface of the tendon by fluid signal. Partial-thickness tears were defined as focal disruption of the tendon by fluid signal but not extending to both tendon surfaces.

The presence of subcortical bone marrow edema or cyst formation in the coracoid or lesser tuberosity was assessed on T2-weighted images. In each study, the subcoracoid interval was measured on axial images. The narrowest distance between the coracoid process and the lesser tuberosity was recorded.

We calculated the incidence and type of subscapularis tendon abnormality in each subgroup: SSnormal, SSvolume loss, and SSfatty atrophy.We also determined the incidence of tears or tendonosis of the infraspinatus and teres minor tendons. For these incidence percentages we calculated the 95% confidence interval per standard statistical formulae [8]. We examined the relationship of subscapularis tendon abnormality with the chronicity of supraspinatus tendon tear and the presence of subcortical edema or cyst formation in the coracoid process and lesser tuberosity using Spearman's correlation test (r). We performed a one-way analysis variance test to determine the relationship between subscapularis tendon abnormality with subcoracoid interval and extent of supraspinatus tear, and we tested pairwise comparisons with Bonferroni t tests.


Results
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 Abstract
 Introduction
 Materials and Methods
 Results
Discussion
 References
 
The sample (Table 1) consisted of 142 shoulder examinations: 63 men and 79 women with a mean age of 57 years (range, 22-78 years) and full-thickness supraspinatus tendon tears. Of these, 45 had a normal supraspinatus muscle (SSnormal), 53 had reduced muscle volume (SSvolume loss), and 44 had fatty atrophy of the supraspinatus muscle (SSfatty atrophy).


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  		TABLE 1: Supraspinatus Muscle Groups and Associated Mean Tendon Tear Size, Subscapularis Tendon Abnormalities, and Mean Subcoracoid Interval

 

The mean anteroposterior dimension of the rotator cuff tear was 8.5 mm in the SSnormal group, 16.6 mm in the SSvolume loss group, and 29 mm in the SSfatty atrophy group. Anteroposterior measurement of rotator cuff tear was within the 1- to 14-mm range in 42 (93%) patients in the SSnormal group, 21(40%) in the SSvolume loss group, and seven (16%) in the SSfatty atrophy group. Anteroposterior measurement of rotator cuff tear was within the 15- to 47-mm range in three (7%) patients in the SSnormal group, 32 (60%) in the SSvolume loss group, and 37 (84%) in the SSfatty atrophy group. There was a correlation of 0.67 (p < 0.001) between chronicity of supraspinatus tendon tear as manifested by the status of the supraspinatus muscle on MRI and anteroposterior extent of tear.

Within the SSnormal group, 35 (78%) patients had a normal subscapularis tendon, five (11%) had subscapularis tendonosis, two (4%) had partial tears of the subscapularis tendon, and three (7%) had full-thickness tears of the subscapularis tendon (Figs. 1A and 1B). Within the SSvolume loss group, 21 (40%) patients had a normal subscapularis tendon, 17 (32%) had subscapularis tendonosis, 10 (19%) had a partial tear of the subscapularis tendon (Figs. 2A and 2B), and five (9%) had full-thickness tears of the subscapularis tendon. Of the SSfatty atrophy group, six (14%) patients had a normal subscapularis tendon, 15 (34%) had subscapularis tendonosis (Figs. 3A, 3B, and 3C), 19 (43%) had partial tears of the subscapularis tendon, and four (9%) had full-thickness tears of the subscapularis tendon. There was moderate correlation (r = 0.47; p < 0.001) between severity of the subscapularis tendon as observed by MRI and chronicity of full-thickness supraspinatus tendon tear manifested by supraspinatus muscle changes.


Figure 1
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  		Fig. 1A —60-year-old man with chronic shoulder pain and dysfunction. Sagittal T2-weighted fast spin-echo image (TR/effective TE, 5,800/80) shows full-thickness tear of supraspinatus (arrow) and subscapularis (arrowhead) tendons.

 

Figure 2
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  		Fig. 1B —60-year-old man with chronic shoulder pain and dysfunction. Axial T2-weighted fast spin-echo image (5,800/80) shows full-thickness tear of subscapularis tendon (arrowhead). Subcortical marrow edema is present in lesser tuberosity (arrow). No edema is present in coracoid process.

 

Figure 3
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  		Fig. 2A —60-year-old woman with chronic shoulder pain. Sagittal T2-weighted fast spin-echo image (TR/effective TE, 5,800/80) shows full-thickness tear of supraspinatus tendon (arrow) and partial-thickness tear of subscapularis tendon (arrowhead).

 

Figure 4
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  		Fig. 2B —60-year-old woman with chronic shoulder pain. Axial T2-weighted fast spin-echo image (5,800/80) shows partial-thickness tear of subscapularis tendon (arrow) with edema in lesser tuberosity (white arrowhead) and subluxation of biceps tendon (black arrowhead).

 

Figure 5
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  		Fig. 3A —40-year-old man with new onset of shoulder pain. Axial T2-weighted fast spin-echo image (TR/effective TE, 5,800/80) shows diffuse enlargement and edema of subscapularis tendon (arrow) consistent with tendonosis.

 

Figure 6
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  		Fig. 3B —40-year-old man with new onset of shoulder pain. Sagittal T2-weighted suppressed fast spin-echo image (5,800/80) shows full-thickness tear of supraspinatus tendon (arrow).

 

Figure 7
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  		Fig. 3C —40-year-old man with new onset of shoulder pain. Sagittal T1-weighted spin-echo image (600/16) shows loss of volume and fatty atrophy of supraspinatus muscle (arrow) with mild loss of volume of subscapularis muscle (arrowhead).

 
Overall within the study group, the subcoracoid interval ranged from 1-19 mm (mean, 8.8 mm). The mean subcoracoid interval was 10.4 mm in the SSnormal subgroup, 8 mm in SSvolume loss group, and 8 mm in SSfatty atrophy group. The analysis of variance of the effect of the group on the interval was significant (F = 10.4; p < 0.0001). The pairwise comparisons between groups SSnormal and SSvolume loss and SSnormal and SSfatty atrophy were significantly different (p < 0.05), but the difference between the SSvolume loss and SSfatty atrophy groups was not. There was mild (r =0.30; p < 0.0001) correlation between chronicity of the supraspinatus tendon tear with subcoracoid interval.

The mean subcoracoid interval was 9.3 mm (range, 5-18 mm) in examinations with a normal subscapularis tendon, 9 mm (range, 5-15 mm) in those with subscapularis tendonosis, 8 mm (range, 3-17 mm) in those with partial tears, and 7.5 mm (range, 1-19 mm) in those with full-thickness tears of the subscapularis tendon. There was no significant correlation (p > 0.05) between the subcoracoid interval and degree of abnormality of the subscapularis tendon.

Bone marrow changes in the lesser tuberosity were seen in two (4%) patients in the SSnormal group, 19 (36%) in the SSvolume loss group, and 25 (57%) in the SSfatty atrophy group. There was a significant relationship between chronicity of supraspinatus tendon tear and presence of bone marrow changes in the lesser tuberosity (r = 0.44; p < 0.0001).

There was subcortical edema and cyst formation in the lesser tuberosity in one (2%) patient with a normal subscapularis tendon, 17 (46%) with subscapularis tendonosis, 22 (71%) with partial tears, and seven (58%) with full-thickness tears of the subscapularis tendon. There was a significant relationship between abnormality of the subscapularis tendon and the presence of lesser tuberosity edema and cyst formation (r = 0.58; p < 0.0001).

There was no subcortical bone marrow edema or cyst formation in the coracoid process in any examination reviewed in this population group.

In this series, 42 (29.6%) of 142 patients had infraspinatus tendonosis, 34 (23.9%) had partial-thickness tendon tears, and 44 (31.0%) had full-thickness tendon tears of the infraspinatus. No teres minor tendon tears were identified. Ten cases (7.0%) of teres minor muscle atrophy were seen.


Discussion
Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
References
 
The subscapularis muscle arises from the anterior scapula and inserts on the lesser tuberosity [6]. Tendon degeneration, degenerative tendon tears, and traumatic tears of the subscapularis tendon are typically located in the superior aspect of the tendon, with the inferior aspect involved in more extensive lesions [6, 7]. Tears of the subscapularis tendon can occur as a component of a massive rotator cuff tear, rotator interval lesions, or in isolation [2, 9, 10]. Isolated complete tear of the subscapularis tendon is rare and is typically associated with forceful external rotation of the adducted arm, anterior shoulder dislocation, or recurrent anterior instability [2, 9, 11]. The anterior extension of a large supraspinatus tendon tear to the subscapularis tendon is more frequent than an isolated traumatic tear [11-14].

Previous studies have reported subscapularis tendon tears in 2% of rotator cuff tears [1]. In our study, the overall incidence of subscapularis tendon tears associated with full-thickness tears of the supraspinatus tendon was 8.4%, higher than previously reported. Overall, 80 (56.3%) patients with full-thickness tears of the supraspinatus tendon had abnormality of the subscapularis tendon on MRI. Forty-three (30%) patients with full-thickness tears of the supraspinatus tendon had associated tears of the subscapularis tendon (22% partial, 8% complete). There was a significant correlation between chronicity and severity of supraspinatus tendon tear with presence of subscapularis tendon abnormality. To our knowledge, no report in the radiology literature has evaluated this relationship.

Subcoracoid impingement is caused by entrapment of a portion of the rotator cuff between the coracoid process and the head of the humerus [15]. Gerber et al. [15] determined that positioning of the shoulder to 90-100° forward flexion and internal rotation significantly decreases the distance between the coracoid and the humeral head (8.7 vs 6.8 mm). Reported MRI signs associated with subcoracoid impingement include subcortical bone marrow edema of the coracoid process and lesser tuberosity associated with reduced subcoracoid interval. Friedman et al. [16] described significant reduction of normal space between the humeral head and the coracoid process in symptomatic patients relative to a healthy population with cine MRI and shoulders positioned in maximal internal rotation. They reported that the average coracohumeral distance in the asymptomatic patient was 11 mm [16]. Although the mean subcoracoid interval of our study population was 8 mm (range, 5-15 mm), no significant relationship was found between the measured subcoracoid interval and severity of subscapularis tendon abnormality.

In this study, images were obtained in the neutral position, allowing assessment of static subcoracoid impingement only. No bone marrow edema or cyst formation in the coracoid process was seen in our study population. Overall, 58% of patients with subscapularis tendon abnormalities had bone marrow edema or cyst formation in the lesser tuberosity and only 2% of patients with a normal subscapularis tendon had bone marrow edema in the lesser tuberosity. Significant correlation was found between the incidence of bone marrow edema and cyst formation in the lesser tuberosity with severity of abnormality of the subscapularis tendon and chronicity of tear of the supraspinatus tendon. To our knowledge. this has never been reported in the radiology literature. One potential explanation for this finding is that with a torn and thus dysfunctional supraspinatus tendon, the normal depressor function on the humeral head is insufficient, giving rise to abnormal mechanical stress on the subscapularis tendon insertion.

Recent surgical literature has suggested the contribution of subcoracoid impingement on rotator cuff dysfunction [17-21]. Suenaga et al. [17] reported persistent pain in patients after rotator cuff repair because of persistent subcoracoid impingement. They concluded that subcoracoid impingement is a potential cause of unsuccessful rotator cuff surgery and recommended coracoplasty in patients with subcoracoid impingement after management of rotator cuff tear [17]. Lo et al. [18, 20] recently reported successful postoperative results in patients who had one-step arthroscopic treatment for subcoracoid and subacromial impingement. However, our findings suggest that static distance between the coracoid and lesser tuberosity is not responsible for the majority of subscapularis tendon abnormalities in this group of patients. Either true subcoracoid impingement is a rare entity or it is anterior shoulder instability that is the true causative factor, creating a dynamic phenomenon related to anterior humeral head subluxation. Lack of corresponding "kissing" marrow changes in the coracoid process argues against static subcoracoid impingement as a cause of subscapularis abnormalities. Subtendinous edema at the lesser tuberosity suggests that with progressive chronicity of supraspinatus tendon tear, there is increase in anterior instability, giving rise to greater mechanical stress by the anterior humeral head on the undersurface fibers of the subscapularis tendon, leading to tendonosis and subsequent tear. Preoperative MRI should evaluate not only for subacromial impingement but also for marrow changes in the region of the lesser tuberosity to allow definitive treatment at surgery and reduce incidence of persistent dysfunction and pain postoperatively. To assess for anterior instability and positional reduction in the subcoracoid interval, dynamic MRI or images obtained in both the neutral and internally rotated positions should be obtained. This is an entity for potential research in this population group.

This study is limited by the lack of clinical and surgical correlation. However, as this was a retrospective study and our referral base was very broad, it was not possible to obtain patient clinical records. Also, lack of standardized clinical assessment would limit the reliability of clinical findings. As the subscapularis tendon is not routinely evaluated at arthroscopy, correlation with surgical reports was not performed.

Selection bias and absence of a control group also limited this study. Using muscle and fat replacement as an analog for tear chronicity has its limitations. However, it is difficult to directly document the onset of rotator cuff tear and we think this is a satisfactory solution. Nevertheless, this study shows a significant relationship between chronicity of full-thickness supraspinatus tendon tears and severity of subscapularis tendon abnormality. It shows a clear relationship between presence of bone marrow edema in the lesser tuberosity with severity and chronicity of supraspinatus tendon tear, suggesting that secondary anterior instability predisposes to subsequent subscapularis tendon abnormality.


References
Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

  1. Li XX, Schweitzer ME, Bifano JA, Lerman J, Manton GL, El-Noueam KJ. MR evaluation of subscapularis tears. J Comput Assist Tomogr 1999; 23:713 -717[CrossRef][Medline]
  2. Gerber C, Krushell R. Isolated rupture of the tendon of the subscapularis muscle: clinical features in 16 cases. J Bone Joint Surg Br 1991; 73:389 -394
  3. Zlatkin MB, Falchook FS. Magnetic resonance pathology of the rotator cuff. Top Magn Reson Imaging1994; 6:94 -120[Medline]
  4. Bonutti PM, Norfray JF, Friedman RJ, Genez BM. Kinematic MRI of the shoulder. J Comput Assist Tomogr 1993;17 : 666-669[Medline]
  5. Rafii M, Firooznia H, Sherman O, et al. Rotator cuff lesions: signal patterns at MR imaging. Radiology1990; 177:817 -823[Abstract/Free Full Text]
  6. Kneeland JB, Middleton WD, Carrera GF, et al. MR imaging of the shoulder: diagnosis of rotator cuff tears. AJR1987; 149:333 -337[Abstract/Free Full Text]
  7. Zlatkin MB, Iannotti JP, Robert MC, et al. Rotator cuff tears: diagnostic performance of MR imaging. Radiology1989; 172:223 -229[Abstract/Free Full Text]
  8. Hays WI. Statistics for psychologists. New York, NY: Holt, Rinehart and Winston, 1963:291
  9. Clark JM, Harryman DT. Tendons, ligaments and capsule of the rotator cuff: gross and microscopic anatomy. J Bone Joint Surg Am 1992; 74:713 -725[Abstract/Free Full Text]
  10. Deutsch A, Altchek D, Veltri D, et al. Traumatic tears of the subscapularis tendon: clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med1997; 25:13 -22[Abstract/Free Full Text]
  11. Symeonides PP. The significance of the subscapularis muscle in the pathogenesis of recurrent anterior dislocation of the shoulder. J Bone Joint Surg Br 1972; 54:476 -483
  12. Nove-Josserand L, Gerber C, Walch G. Lesions of the anterosuperior rotator cuff. In: Warner JJP, Iannotti JP, Gerber C, eds. Complex and revision problems in shoulder surgery. Philadelphia, PA: Lippincott-Raven, 1997:165 -176
  13. Warner JJP, Answorth AA, Gerber C. Diagnosis and management of subscapularis tendon tears. Tech Orthop1994; 9:116 -125[CrossRef]
  14. Walch G, Nove-Josserand L, Levigne C, Renaud E. Tears of the supraspinatus tendon associated with "hidden" lesions of the rotator interval. J Shoulder Elbow Surg1994; 3:353 -360
  15. Gerber C, Terrier F, Zehnder R, Ganz R. The subcoracoid space: an anatomic study. Clin Orthop Relat Res1987; 215:132 -138
  16. Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. Orthopedics1998; 21:545 -548[Medline]
  17. Suenaga N, Minami A, Kaneda K. Postoperative subcoracoid impingement syndrome in patients with rotator cuff tear. J Shoulder Elbow Surg 2000; 9:275 -278[CrossRef][Medline]
  18. Lo IK, Parten PM, Burkhart SS. Combined subcoracoid and subacromial impingement in association with anterosuperior rotator cuff tears: an arthroscopic approach. Arthroscopy 2003;19 : 1068-1078[Medline]
  19. Dumontier C, Sautet A, Gagey A, Apoil A. Rotator interval lesions and their relation to coracoid impingement syndrome. J Shoulder Elbow Surg 1999; 8:130 -135[CrossRef][Medline]
  20. Lo IK, Burkhart SS. The etiology and assessment of subscapularis tendon tears: a case for subcoracoid impingement, the roller-wringer effect, and TUFF lesions of the subscapularis. Arthroscopy2003; 19:1142 -1150[Medline]
  21. Kim TK, Rauh PB, McFarland EG. Partial tears of the subscapularis tendon found during arthroscopic procedures on the shoulder: a statistical analysis of sixty cases. Am J Sports Med2003; 31:744 -750[Abstract/Free Full Text]

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