Supraspinatus Tendonitis Workup
- Author: Thomas M DeBerardino, MD; Chief Editor: Sherwin SW Ho, MD more...
Imaging Studies
- Standard radiographic studies are used to rule out glenohumeral/acromioclavicular arthritis and Os Acromiale.
- Anteroposterior view of the glenohumeral joint
- Internal rotation view of the humerus with a 20° upward angulation to show the acromioclavicular joint
- Axillary view - Most useful to rule out subtle signs of instability (eg, glenoid avulsion, Hill-Sachs lesion) and to visualize the presence of an os acromiale
- Stryker notch view - Potential os acromiale is easily visualized and assessed when viewed through the humeral head
- Supraspinatus outlet view - Most useful to assess the supraspinatus outlet space (If < 7 mm, the patient is more at risk for impingement syndrome.) and helps assess morphology of the acromion (A hooked acromion is more at risk for impingement.)
- MRI is considered the imaging study of choice for shoulder pathology.
- Advantages
- Noninvasive
- No radiation
- Can detect intrasubstance tendon degeneration or partial rotator cuff tears
- Can detect inflammation, edema, hemorrhage, and scarring
- Can be used with an intra-articular contrast agent (eg, gadolinium), improving its ability to detect partial rotator cuff tears
- Disadvantages
- Often cannot accommodate patients with claustrophobia
- Often cannot accommodate larger patients
- Cannot accommodate patients with pacemakers, other metal implants, or particles
- Dependent on quality of the MRI machine
- Dependent on the skill of the technician performing the imaging and the radiologist interpreting the images
- High cost
- Advantages
- For arthrography, dye is injected into the glenohumeral joint and postinjection radiographs are taken to assess the integrity of the glenohumeral joint.
- Can be used to evaluate rotator cuff tears (A finding of dye escaping out of the joint and into the subacromial space is diagnostic of a full-thickness rotator cuff tear.)
- Advantages - Can be used in conjunction with a CT scan to evaluate intra-articular pathology (eg, Bankart tears) and has a low cost
- Disadvantages - Size of the tears cannot be quantified, patient is exposed to radiation and contrast dye, procedure is invasive
- Diagnostic arthroscopy
- Minimally invasive, visual, surgical procedure to assess shoulder pathology
- Can visualize and assess most shoulder pathology
- May afford the patient and physician a chance to diagnose and treat the pathology with one procedure
- Disadvantage - May miss capsular-sided, partial-thickness tears
- Note: A workup for other, more systemic processes may be included as clinically indicated.
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