Acromial spur: Relationship to aging and morphologic changes in the rotator cuff

doi:10.1016/j.jse.2005.03.007

Journal of Shoulder and Elbow Surgery

Volume 14, Issue 6, November–December 2005, Pages 591-598

https://doi.org/10.1016/j.jse.2005.03.007 Get rights and content

This study’s objective is to elucidate the relationship between acromial spur formation and rotator cuff pathology or aging. The subjects comprised 1029 shoulders in control, cadaveric, and operative groups. A radiograph in the supraspinatus outlet view was taken in all subjects. The lengths of the incident spurs were measured and classified into 3 sizes (small, <5 mm; medium, <10 mm; and large, ≥10 mm). The rotator cuff was macroscopically classified as normal or as having bursal-side fraying, joint-side tear, intratendinous tear, bursal-side tear, complete tear limited to the supraspinatus tendon, or massive tear. In the control group, the overall incidence of spurs and spur size increased with advancing age (P < .001), but the majority of spurs were small (<5 mm). In the cadaveric group, the overall incidence did not correlate with advancing age (P > .05). However, spur size increased with age in subjects aged 50 years or older (P < .001). The incidence of spurs in rotator cuffs with bursal-side tears was highest and was significantly higher than that in normal cuffs and cuffs with bursal-side fraying and intratendinous tears. We observed 40% of medium spurs and 69% of large spurs in cases with bursal-side tears, complete tears limited to the supraspinatus tendon, and massive tears. In the operative group, the overall incidence correlated to advancing age (P < .001), reaching 80% or more in subjects aged 30 years or older. In addition, the size of spurs was larger than that in the other 2 groups in all age groups with few exceptions (P < .05). Small spurs were associated with advancing age. Morphologic change to the bursal side of the rotator cuff may enhance spur growth. The presence of a small spur has no diagnostic value for rotator cuff tears. Spurs measuring 5 mm or more, however, are of diagnostic value because of their high rate of association with bursal-side tear, complete tears limited to the supraspinatus tendon, or massive tears.

Section snippets

Materials and methods

The subjects comprised 1029 shoulders in 3 groups: control, cadaveric, and operative (Table I). The control group consisted of asymptomatic joints of volunteers with neither a history of trauma or pain nor any physical findings of impairment including cuff muscle atrophy. Excluded were shoulders with such abnormal radiographic findings as recession or obvious spur formation of the greater tuberosity and narrowing of the acromiohumeral interval, except for acromial spur formation or degenerative

Results

In the control group, spurs started to appear in the 20- to 29-year age decade. The overall incidence increased with advancing age, but the majority of spurs were small and the overall incidence of medium or large spurs was 7%. Spur size increased with advancing age (P < .001). Medium and large spurs appeared in the 40- to 49-year age decade and older subjects, and their incidence increased with advancing age (P < .001) (Figure 2). However, more adequately expressed is that medium and large

Discussion

Since the study by Neer23, 24 on the relationship between rotator cuff lesion and acromial spur formation, many studies on this subject have been reported.^† Notably, Hardy et al¹⁶ reported that the most common radiographic abnormality in patients with acute impingement syndrome was subacromial bony proliferation, seen in 68%. Cone et al¹¹ emphasized that the acromial spur was a traction spur developed at the insertion of the coracoacromial ligament to the acromion and that the presence of

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Cited by (73)

Alteration of coracoacromial ligament thickness at the acromial undersurface in patients with rotator cuff tears
2022, JSES International
Some researchers have stated that magnetic resonance imaging (MRI) is useful for assessing the coracoacromial ligament (CAL) at the acromial undersurface. However, few studies have investigated the reliability and clinical significance of MRI findings for the CAL at the acromial undersurface. The purpose of this study was to determine the association between CAL thickness at the acromial undersurface and rotator cuff tear size.
The CAL thickness at the acromial undersurface was evaluated in 182 patients with rotator cuff tears (mean age: 64.9 ± 8.4 years) using a 3.0-Tesla MRI system. The association between CAL thickness at the acromial undersurface and rotator cuff tear size determined by the DeOrio and Cofield classification (partial; small: <1 cm; medium: 1-3 cm; and large or massive: >3 cm) was analyzed statistically. The intraobserver and interobserver reliabilities for MRI measurements of CAL thickness at the acromial undersurface were determined by calculation of intraclass correlation coefficients and their 95% confidence intervals.
The mean CAL thickness at the acromial undersurface was 2.7 ± 1.4 mm (range: 0-6.5 mm). Increasing rotator cuff tear size was significantly associated with decreasing CAL thickness at the acromial undersurface (P = .004). The intraobserver and interobserver intraclass correlation coefficients for CAL thickness at the acromial undersurface were almost perfect (0.98 and 0.91, respectively).
The present study clarified that (1) MRI was a reliable tool for evaluation of CAL thickness at the acromial undersurface and (2) increasing rotator cuff tear size was significantly associated with decreasing CAL thickness at the acromial undersurface. These findings may assist toward understanding the progressive pathology in rotator cuff disease.
Are critical shoulder angle and acromion index correlated to the size of a rotator cuff tear
2022, Orthopaedics and Traumatology: Surgery and Research
Scapular morphology is an extrinsic factor playing role in rotator cuff tear (RCT) etiology. The objective of this study was to evaluate the relationship between critical shoulder angle (CSA) and acromion index (AI) with partial-bursal side and full thickness RCT and the size of the RCT.
The hypothesis was that CSA and AI would be greater in partial bursal-side RCT and full-thickness RCT patients and would increase with the size of the RCT.
This retrospective study assessed 218 patients who had standard shoulder radiographs and magnetic resonance imaging. Patients were divided into three groups: intact rotator cuff (68), partial bursal-side RCT (34) and full-thickness RCT (116). In the second part, full-thickness RCT patients were divided into four groups according to RCT size; small (<1 cm), medium (1-3 cm), large (3-5 cm) and massive (>5 cm). AI and CSA measurements were evaluated from radiographs.
The mean CSA was 32.8̊ in control group, 34.3̊ in partial group and 36.9̊ in full-thickness group. The mean AI was 0.66, 0.68 and 0.72 respectively. Significant difference was found in AI and CSA between full thickness RCT and intact RC group (p < 0.01), and partial RCT and full thickness RCT group (p < 0.05) in paired comparisons. In full thickness RCT size groups the mean CSA was 34.2̊, 36.4̊, 39.0̊ and 40.8̊ and mean AI was 0.70, 0.71, 0.73 and 0.79 respectively. Significant difference was found between small-large, small-massive, medium-massive groups for CSA in paired comparisons and between small-massive, medium-massive groups for AI.
CSA and AI were significantly greater in full-thickness RCT patients and the size of the RCT increased with CSA and AI. The greater CSA and AI could be predictors for larger RCT.
III; Cross-Sectional Design; Prognosis Study.
Sharpened lateral acromion morphology (SLAM sign) as an indicator of rotator cuff tear: a retrospective matched study
2021, JSES International
Bigliani types of acromion and critical shoulder angle (CSA) have been implicated as indicators of rotator cuff disease. A sharpened inferolateral edge of acromion (termed as Sharpened Lateral Acromion Morphology or SLAM sign) is frequently observed in anteroposterior radiographs of the glenohumeral joint in patients with rotator cuff tears (RCT). We aimed to evaluate the association of the SLAM sign with RCT in comparison to high CSA (≥35°) and Bigliani type 3 (hooked) acromion.
A cohort of 100 consecutive patients undergoing non-arthroplasty surgery for RCT and 106 patients with primary frozen shoulder were matched manually in 1:1 ratio based on age and gender to yield study population with 50 patients in each group. The 2 groups were compared for the presence of the SLAM sign, high CSA, and type 3 acromion on the radiographs.
All the 3 parameters were found more prevalent in the RCT group than the frozen shoulder group (SLAM, 46% vs. 0; high CSA, 60% vs. 40%; type 3 acromion, 18% vs. 4%) (P < .05). The SLAM sign showed stronger correlation with RCT than high CSA and type 3 acromion (Ps = 0.562 vs. 0.220 vs. 0.224 respectively).
The SLAM sign is a simple and easily identifiable radiological predictor of rotator cuff disease.
Influence of Radiographic Parameters on Reduction of the Critical Shoulder Angle With Arthroscopic Lateral Acromioplasty—A Mathematical Model
2021, Arthroscopy, Sports Medicine, and Rehabilitation
To develop a mathematical model for the preoperative planning of arthroscopic lateral acromioplasty (ALA) and to evaluate the role of radiographic parameters with regards to the critical shoulder angle (CSA).
Anteroposterior (AP) radiographs of patients who underwent rotator cuff surgery were screened to identify true AP radiographs. Radiographs were assessed for (1) native CSA, (2) CSA after simulated resection of a spur if present, (3) amount of ALA necessary to achieve a CSA of 34°, (4) CSA after 5-mm ALA, (5) lateral acromion angle, (6) acromion index, and (7) sclerosis of the greater tuberosity.
A total of 1191 radiographs were screened. Of the 124 patients included, the native CSA was large (≥35°) in 56 patients (45%). In 30 patients (24%), a subacromial spur was detected and resection reduced the CSA by a median of 2°. Spur resection alone reduced the CSA to ≤34° in 19 patients (15.3%). Mean amount of ALA to achieve a CSA of 34° was 3.9 ± 1.8 mm, and this value strongly correlated with the CSA before ALA (R = 0.88, P < .001). The linear regression model to determine the amount of ALA to achieve a CSA of 34° was as follows: $R e q u i r e d A L A i n m m = - 39.120 + 1.165 * C S A_{n a t i v e}$ The multiple R² for this model was 0.777. Mean reduction of CSA by 5-mm ALA was 3.8 ± 0.8° and 75% of large CSAs were reduced to a CSA of 30-34°. The acromion index had no significant independent influence on the model (P = .427), whereas lateral acromion angle was an independently significant predictor of required ALA to achieve a CSA of 34° (P = .019). Sclerosis of the greater tuberosity was significantly associated with a CSA of 35° or greater (P = .003).
The amount of ALA needed to reduce a large CSA to 34° correlates with the CSA before ALA and can preoperatively be planned with the use of a simple equation.
Level III; cross-sectional design; epidemiology study.
Risk factors for and prognosis of folded rotator cuff tears: a comparative study using propensity score matching
2021, Journal of Shoulder and Elbow Surgery
The prognosis of rotator cuff repair (RCR) may be affected by the shape and quality of the torn rotator cuff tendon. However, only a few studies have reported on folded rotator cuff tears (FCTs). Therefore, this study aimed to evaluate the prognostic factors for FCT and clinical outcomes of FCT repair.
Through propensity score matching (PSM), 200 (40 patients with FCTs and 160 controls) of 1927 patients who underwent RCR from 2010 to 2016 were included. The variables not used for PSM were compared. The anatomic and functional outcomes were assessed at the final follow-up (32.3 ± 21.2 months), and the related prognostic factors for FCTs were evaluated.
The risk factors for FCT were heel-type spur (odds ratio [OR], 11.6; P < .001) and delamination (OR, 2.3; P = .034). Although the functional scores at the final follow-up for both groups improved postoperatively and were not significantly different, the visual analog scale scores for pain (1.9 ± 2.1 vs. 1.2 ± 1.7, P = .034) and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores (83.1 ± 14.3 vs. 88.5 ± 12.2, P = .018) were significantly worse in the FCT group at 6 months postoperation. The retear rate was significantly higher in the FCT group (25.0 vs. 10.0%, P = .018). An FCT was a significant risk factor for retears (OR, 3.0; P = .015); however, a subgroup analysis revealed that the retear rate according to the management strategy for the folded portion (débridement of the folded portion vs. en masse repair including the folded portion) was not significantly different (26.7 vs. 24.0%, P > .99).
The risk factors for FCTs were heel-type spur and delamination. The retear rate was significantly higher for patients with FCTs. An FCT was indicative of poor quality of the remaining tendon; therefore, FCT may be a prognostic factor for worse functional outcomes during the early postoperative period and poor healing potential.
Fibrosis in the rotator interval associated with articular vs. bursal side partial-thickness rotator cuff tears
2020, JSES International
The pathogenesis of articular- and bursal-sided partial-thickness rotator cuff tears (PTRCTs) is considered to be different, and associated lesions with PTRCTs need to be examined.
The current study consisted of 76 shoulders of 73 patients (27 men, 46 women, 64.0 ± 8.3 years old) who underwent mini-open repair after conversion to full-thickness tears for either articular side (group A; n = 56) or bursal side (group B; n = 20) PTRCT with at least a 2-year follow-up. Clinical outcomes and their images were compared between the groups. Plain radiographs were used with the arm passively elevated in maximum elevation to assess restriction of glenohumeral motion.
The retear rate was not significantly different between the groups. Both groups showed significant improvement in functional scores at the final follow-up. Patients in group A showed a higher incidence of preoperative fibrosis in the rotator interval (69.6% vs. 35.0%, respectively; P = .006) and a lower incidence of an acromial spur (7.1% vs. 35.0%, respectively; P = .008) compared with group B. Plain radiographs with arm elevation showed restriction of glenohumeral movement in 49 of 76 shoulders (64.5%) preoperatively, including 36 of the 46 shoulders with fibrosis and 13 of the other 30 shoulders.
Both articular- and bursal-sided PTRCTs showed significant functional improvements after surgery. The articular-sided tears had a lower incidence of an acromial spur, but had a higher incidence of fibrosis in the rotator interval, which led to a limitation in glenohumeral motion.

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Original articleAcromial spur: Relationship to aging and morphologic changes in the rotator cuff

Section snippets

Materials and methods

Results

Discussion

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Arthroscopy

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Morphometry of the sub-acromial space and its clinical relevance

Unfallchirurg

The slope of the acromion and rotator cuff teara cadaveric study

Clinical application for measuring the slope of the acromion

The morphology of the acromion and its relationship to rotator cuff tears

Orthop Trans

The relationship of age, gender, and degenerative changes observed on radiographs of the shoulder in asymptomatic individuals

J Bone Joint Surg Br

Reliability of radiographic evaluation for acromial morphology

Skeletal Radiol

Incidence of acromial spur

J Shoulder Elbow Surg

Histologic findings in clinical coracoacromial arch impingement

Orthop Trans

Rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa

Original article
Acromial spur: Relationship to aging and morphologic changes in the rotator cuff