Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
권호 표지
DOI QR코드

DOI QR Code

A Novel Method to Measure Superior Migration of the Humeral Head: Step-off of the C-line

  • Park, Kyoung Jin (Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine) ;
  • Eun, Hyeon Jun (Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine) ;
  • Kim, Yong Min (Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine) ;
  • Yoo, Jun Il (Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine) ;
  • Lim, Chae Ouk (Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine)
  • 투고 : 2015.08.23
  • 심사 : 2016.01.06
  • 발행 : 2016.09.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Superior migration of humeral head has been conventionally determined by measuring the acromiohumeral distance (AHD), We sought to devise a novel measurement system more reliably and accurately than AHD. We described a structural landmark called 'C-line'. In this study, we investigated the clinical usefulness of 'step-off of the C-line (SOC)' compared to that of AHD. Methods: The C-line formed from the medial margin of the proximal humeral head continuing up to the inferior margin of the articular glenoid and then to the lateral border of the scapula. The superior migration of the humeral head triggered by a rotator cuff tear introduces a discontinuity in this C-line. We measured the distance of this discontinuity. We enrolled 144 patients who underwent a rotator cuff repair. We selected 58 controls who didn't have any cuff lesions apparent on magnetic resonance imaging. Using radiographs derived from standardized true anteroposterior views of the shoulder, we measured the SOC and the AHD. We used t-tests for statistical analyses. Results: A rotator cuff tear was associated with an increase in SOC and a decrease in AHD. In control group, the mean SOC was $1.29{\pm}1.71mm$ and AHD was $9.71{\pm}2.65mm$. In cuff tear group, the mean SOC was $3.15{\pm}3.41mm$ and AHD was $8.28{\pm}1.76mm$. The mean SOCs of the patient group in relation to the mean SOC of the control group according to tear size, the SOCs of medium tear and lager groups showed statistically significant increase (p<0.05). Conclusions: The SOC may be a similarly effective to diagnose cuff tears of medium size and larger compared with AHD.

키워드

참고문헌

  1. Bartolozzi A, Andreychik D, Ahmad S. Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res. 1994;(308):90-7.
  2. Nove-Josserand L, Edwards TB, O'Connor DP, Walch G. The acromiohumeral and coracohumeral intervals are abnormal in rotator cuff tears with muscular fatty degeneration. Clin Orthop Relat Res. 2005;(433):90-6.
  3. Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg. 2003;12(6):550-4. https://doi.org/10.1016/S1058-2746(03)00211-8
  4. Kotzen LM. Roentgen diagnosis of rotator cuff tear. Report of 48 surgically proven cases. Am J Roentgenol Radium Ther Nucl Med. 1971;112(3):507-11. https://doi.org/10.2214/ajr.112.3.507
  5. Moosikasuwan JB, Miller TT, Burke BJ. Rotator cuff tears: clinical, radiographic, and US findings. Radiographics. 2005;25(6):1591-607. https://doi.org/10.1148/rg.256045203
  6. Nove-Josserand L, Levigne C, Noel E, Walch G. The acromiohumeral interval. A study of the factors influencing its height. Rev Chir Orthop Reparatrice Appar Mot. 1996;82(5):379-85.
  7. Gruber G, Bernhardt GA, Clar H, Zacherl M, Glehr M, Wurnig C. Measurement of the acromiohumeral interval on standardized anteroposterior radiographs: a prospective study of observer variability. J Shoulder Elbow Surg. 2010;19(1):10-3. https://doi.org/10.1016/j.jse.2009.04.010
  8. Hebert LJ, Moffet H, Dufour M, Moisan C. Acromiohumeral distance in a seated position in persons with impingement syndrome. J Magn Reson Imaging. 2003;18(1):72-9. https://doi.org/10.1002/jmri.10327
  9. Iannotti JP. Full-thickness rotator cuff tears: factors affecting surgical outcome. J Am Acad Orthop Surg. 1994;2(2):87-95. https://doi.org/10.5435/00124635-199403000-00002
  10. Golding FC. The shoulder: the forgotten joint. Br J Radiol. 1962;35:149-58. https://doi.org/10.1259/0007-1285-35-411-149
  11. Weiner DS, Macnab I. Superior migration of the humeral head. A radiological aid in the diagnosis of tears of the rotator cuff. J Bone Joint Surg Br. 1970;52(3):524-7.
  12. Krishnan SG, Bennion PW, Reineck JR, Burkhead WZ. Hemiarthroplasty for proximal humeral fracture: restoration of the Gothic arch. Orthop Clin North Am. 2008;39:441-50. https://doi.org/10.1016/j.ocl.2008.05.004
  13. Keener JD, Wei AS, Kim HM, Steger-May K, Yamaguchi K. Proximal humeral migration in shoulders with symptomatic and asymptomatic rotator cuff tears. J Bone Joint Surg Am. 2009;91:1405-13. https://doi.org/10.2106/JBJS.H.00854
  14. Mura N, O'Driscoll SW, Zobitz ME, et al. The effect of infraspinatus disruption on glenohumeral torque and superior migration of the humeral head: a biomechanical study. J Shoulder Elbow Surg. 2003;12(2):179-84. https://doi.org/10.1067/mse.2003.9
  15. Mochizuki T, Sugaya H, Uomizu M, et al. Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. J Bone Joint Surg Am. 2008;90(5):962-9. https://doi.org/10.2106/JBJS.G.00427
  16. Saupe N, Pfirrmann CW, Schmid MR, Jost B, Werner CM, Zanetti M. Association between rotator cuff abnormalities and reduced acromiohumeral distance. AJR Am J Roentgenol. 2006;187(2):376-82. https://doi.org/10.2214/AJR.05.0435