Skip to main content
SpringerLink
Log in
Book cover

Measurements in Musculoskeletal Radiology pp 237–300Cite as

Shoulder

  • Chapter
  • First Online:

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

Over the last 20 years the “forgotten” shoulder joint has attracted a lot of orthopaedic attention primarily focused on rotator cuff disease, instability and arthroplasty. New orthopaedic concepts and a better understanding of the relationship between shoulder structure and function have increased the role of, and demand for imaging of the shoulder. With this increased interest, an increased application of imaging methods has evolved to support diagnosis, therapeutic decision making and outcome assessment. Revisiting the conventional radiograph has led to the creation and harnessing of a number of measurements, whose values relate not only to structural relationships but more importantly to shoulder function. Increasingly, these values are sought for before arthroscopic procedures but also prior to carrying out a shoulder replacement, to optimise the choice and ensure accurate placement of the implanted prosthesis. Cross-sectional imaging (CT and MRI) has also been used to provide accurate measurement of important structures such as the glenoid and acromion, whose morphology is difficult to ascertain with conventional radiography. These techniques along with ultrasound also provide visualisation of the soft tissues of the shoulder, which are increasingly being employed in providing qualitative and quantitative values to aid clinical diagnosis and management.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   289.00
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  • Aoki M, Ishii S, Usui M (1986) The slope of the acromion and rotator cuff impingement. Orthop Trans 10:228

    Google Scholar 

  • Azzoni R, Cabitza P, Parrini M (2004) Sonographic evaluation of subacromial space. Ultrasonics 42:683–687

    Article  CAS  PubMed  Google Scholar 

  • Banas MP, Miller RJ, Totterman S (1995) Relationshio between the lateral acromion angle and rotator cuff disease. J Shoulder Elb Surg 4:454–461

    Article  CAS  Google Scholar 

  • Bey M, Brock S, Beierwaltes W et al (2007) In vivo measurement of subacromial space width during shoulder elevation: technique and preliminary results in patients following unilateral rotator cuff repair. Clin Biomech Aug 22(7):767–773

    Article  Google Scholar 

  • Bigliani L, Morrison DS, April EW (1986) The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 10:228

    Google Scholar 

  • Bokor DJ, O’Sullivan MD, Hazan GJ (1999) Variability of measurement of glenoid version on computed tomography scan. J Shoulder Elb Surg 8:595–598

    Article  CAS  PubMed  Google Scholar 

  • Bouaicha S, Ehrmann C, Slankamenac K, Regan WD, Moor BK (2014) Comparison of the critical shoulder angle in radiographs and computed tomography. Skeletal Radiol 43:1053–1056

    Article  PubMed  Google Scholar 

  • Brewer BJ, Wubben RC, Carrera GF (1986) Excessive retroversion of the glenoid cavity. J Bone Joint Surg (Am) 68:724–731

    Article  CAS  Google Scholar 

  • Cone RO, Danzig L, Resnick D, Goldman AB (1983) The bicipital groove: radiographic, anatomic, and pathologic study. Am J Roentgenol 141:781–788

    Article  CAS  Google Scholar 

  • Cotton RE, Rideout DF (1964) Tears of the humeral rotator cuff: a radiological and pathological necropsy survey. J Bone Joint Surg 46:314–318

    Article  CAS  Google Scholar 

  • Deutsch A, Altchek DW, Schwartz E, Otis JC, Warren RF (1996) Radiological measurement of superior displacement of the humeral head in the impingement syndrome. J Shoulder Elb Surg 5:186–193

    Article  CAS  Google Scholar 

  • Di Mario M, Fraracci L (2005) MR study of the intrinsic acromial angle in 74 symptomatic patients. Radiol Med 110:273–279

    PubMed  Google Scholar 

  • Dias JJ, Mody BS, Finlay DB, Richardson RA (1993) Recurrent anterior glenohumeral joint dislocation and torsion of the humerus. Injury 24:329–332

    Article  CAS  PubMed  Google Scholar 

  • Dowdy PA, O’Driscoll SW (1994) Recurrent anterior shoulder instability. Am J Sports Med 22(4):489–492

    Article  CAS  PubMed  Google Scholar 

  • Dumontier C, Sauter A, Gagey O, Apoil A (1999) Rotator interval lesions and their relation to coradoid impingement syndrome. J Shoulder Elb Surg 8(2):130–135

    Article  CAS  Google Scholar 

  • Edelson JG, Taitz C (1992) Anatomy of the coracoacromial arch. Relation to degeneration of the acromion. J Bone Joint Surg Br 74:589–594

    Article  CAS  PubMed  Google Scholar 

  • Friedman RJ, Hawthorne KB, Genez BM (1992) The use of computerized tomography in the measurement of glenoid version. J Bone Joint Surg Am 74:1032–1037

    Article  CAS  PubMed  Google Scholar 

  • Friedman RJ, Bonutti PM, Genez B (1998) Cine magnetic resonance imaging of the subcoracoid space. Orthopaedics 21:545–548

    CAS  Google Scholar 

  • Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elb Surg 8:599–605

    Article  CAS  Google Scholar 

  • Garcia GH, Lui JN, Degen RM, Johnson CC, Wong A, Dines DM, Gulotta LV, Dines JS (2017) Higher critical shoulder angle increases the risk of retear after rotator cuff repair. J Shoulder Elbow Surg 26:241–245

    Article  PubMed  Google Scholar 

  • Gardner E, Grey DJ (1953) Prenatal development of the human shoulder and acromioclavicular joint. Am J Anat 92:219–276

    Article  CAS  PubMed  Google Scholar 

  • Gerber C, Terrier F, Ganz R (1987) The subcoracoid space: an anatomic study. Clin Orthop 215:132–138

    Google Scholar 

  • Golding C (1962) The shoulder: the forgotten joint. Br J Radiol 35:149–458

    Article  CAS  PubMed  Google Scholar 

  • Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures : pre and postoperative evaluation by CT scan. Clin Orthop Rel Res 304:78–83

    Google Scholar 

  • Graichen H, Bonel H, Stammberger T, Englmeier KH, Reiser M, Eckstein F (1999) Subacromial space width changes during abduction and rotation: a 3-D MR imaging study. Surg Radiol Anat 21:59–64

    Article  CAS  PubMed  Google Scholar 

  • Grasshoff H, Buhtz C, Gellerich I, Von Knorre C (1991) CT diagnosis in instability of the shoulder joint. ROFO 155(6):523–526

    Article  CAS  PubMed  Google Scholar 

  • Green A, Griggs S, Labrador D (2004) Anterior acromial anatomy: relevance to arthroscopic acromioplasty. Arthroscopy 20:1050–1054

    Article  PubMed  Google Scholar 

  • Griffith JF, Antonio GE, Tong CW, Ming CK (2003) Anterior shoulder dislocation: quantification of glenoid bone loss with CT. Am J Roentgenol 180:1423–1430

    Article  Google Scholar 

  • Griffith JF, Antonio GE, Yung PSH, Wong EMC, Yu AB, Ahhuja AT, Chan KM (2007) Prevalence, pattern and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients. Am J Roentgenol 190:1247–1254

    Article  Google Scholar 

  • Hamid N, Omid R, Yamaguchi K, Steger-May K, Stobbs G, Keener JD (2012) Relationship of radiographic acromial characteristics and rotator cuff disease: a prospective investigation of clinical, radiographic, and sonographic findings. J Shoulder Elbow Surg 21:1289–1298

    Article  PubMed  PubMed Central  Google Scholar 

  • Haygood TM, Langlotz CP, Kneeland JB, Ianotti JP, Williams GR, Dalinka MK (1994) Categorisation of acromial shape: interobserver variability with MR imaging and conventional radiography. Am J Roentgenol 162:1377–1382

    Article  CAS  Google Scholar 

  • Hebert LJ, Moffet H, Dufour M, Moisan C (2003) Acromiohumeral distance in a seated position in persons with impingement syndrome. J Magn Reson Imaging 18:72–79

    Article  PubMed  Google Scholar 

  • Heuberer PR, Plachel F, Willinger L, Moroder P, Laky B, Pauzenberger L, Lomoschitz F, Anderl W (2017) Critical shoulder angle combined with age predict five shoulder pathologies: a retrospective analysis of 1000 cases. BMC Musculoskelet Disord 18:259

    Article  PubMed  PubMed Central  Google Scholar 

  • Hirschfelder H, Kirsten U (1991) Biometric analysis of the unstable shoulder. Z Orthop Ihre Grenzgeb 129(6):516–520

    Article  CAS  PubMed  Google Scholar 

  • Hitchcock HH, Bechtol CO (1948) Painful shoulder. J Bone Joint Surg Am 30:262–273

    Article  Google Scholar 

  • Hoenecke HR Jr, Hermida JC, Flores-Hernandez C, D’Lima DD (2010) Accuracy of CT-based measurements of glenoid version for total shoulder arthroplasty. J Shoulder Elb Surg 19:166–171

    Article  Google Scholar 

  • Hughes RE, Bryant CR, Hall JM et al (2003) Glenoid inclination is associated with full-thickness rotator cuff tears. Clin Orthop Relat Res 407:86–91

    Article  Google Scholar 

  • Ianotti JP, Gabriel JP, Schneck SL, Evans BG, Masra S (1992) Normal glenohumaral relationship: an anatomic study of one hundred and forty shoulders. J Bone Joint Surg 74:491–500

    Article  Google Scholar 

  • Kasra R (2010) Development of fatty atrophy. J Bone Joint Surg 92:2270–2278

    Article  Google Scholar 

  • Kitay GS, Ianotti JP, Williams GR, Haygood T, Kneeland JB, Berlin J (1995) Roentgenographic assessment of acromial morphologic condition in rotator cuff impingement syndrome. J Shoulder Elb Surg 4:441–448

    Article  CAS  Google Scholar 

  • Leclercq R (1950) Diagnostic de la rupture du sus-epineux. Rev Rhum 10:510–515

    Google Scholar 

  • Lehtinen JT, Lehto MUK, Kaarela K, Kautiainen HJ, Belt EA, Kauppi MJ (2000) Radiographic joint space in rheumatoid glenohumeral joints. A 15-year prospective follow-up study in 74 patients. Rheumatology 39:288–292

    Article  CAS  PubMed  Google Scholar 

  • Lo IK, Burkhart SS (2003) The etiology and assessment of subscapularis tendon tears: a case for subcoracoid impingement, the roller-wringer effect, and TUFF lesions of the subscapularis. Arthroscopy 19:1142–1150

    Article  PubMed  Google Scholar 

  • Mallon WJ, Brown HR, Vogler JB, Martinez S (1992) Radiographic and geometric anatomy of the scapula. Clin Orthop 277:142–154

    Google Scholar 

  • Maurer A, Fucentese SF, Pfirrmann CWA, Wirth SH, Djahangiri A, Jost B, Gerber C (2011) Assesment of glenoid inclination on routine clinical radiographs and computed tomography examinations of the shoulder. J Shoulder Elb Surg 1:1–8

    Google Scholar 

  • Mayerhoefer ME, Breitenseher M, Roposch A, Treitl C, Wurnig C (2005) Comparison of MRI and conventional radiography for assessment of acromial shape. Am J Roentgenol 184:671–675

    Article  Google Scholar 

  • Mintzer CM, Waters PM, Brown DJ (1996) Glenoid version in children. J Pediatr Orthop 16:563–566

    Article  CAS  PubMed  Google Scholar 

  • Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C (2013) Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint? Bone Joint J 95-B:935–941

    Article  CAS  PubMed  Google Scholar 

  • Moor BK, Wieser K, Slankamenac K, Gerber C, Bouaicha S (2014a) Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elbow Surg 23(4):536–541

    Article  PubMed  Google Scholar 

  • Moor BK, Rothlisberger M, Muller DA, Zumstein MA, Bouaicha S, Ehlinger M, Gerber C (2014b) Age, trauma and the critical shoulder angle accurately predict supraspinatus tendon tears. Orthop Traumatol Surg Res 100:489–494

    Article  CAS  PubMed  Google Scholar 

  • Moses DA, Chang EY, Schweitzer ME (2006) The scapuloacromial angle: a 3D analysis of the acromial slope and its relationship with shoulder impingement. J Magn Res Imaging 24:1371–1377

    Article  Google Scholar 

  • Mullaji AB, Beddow FH, Lamb GHR (1994) CT measurement of glenoid erosion in arthritis. J Bone Joint Surg (Br) 76-B:384–388

    Article  Google Scholar 

  • Natsis K, Tsikaras P, Totlis T (2007) Correlation between the four types of acromion and the existence of enthesophytes: a study on 423 dried scapulas and review of the literature. Clin Anat 20:267–272

    Article  CAS  PubMed  Google Scholar 

  • Nyffeler RW, Jost B, Pfirrmann CWA, Gerber C (2003) Measurement of glenoid version: conventional radiographs versus computed tomography scans. J Shoulder Elb Surg 12(5):493–496

    Article  Google Scholar 

  • Nyffeler RW, Werner CML, Sukthanakar A, Schmid MR, Gerber C (2006) Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am 88-A:800–805

    Google Scholar 

  • Petersson CJ, Redlund-Johnell I (1983) Joint space in normal gleno-humeral radiographs. Acta Orthop Scand 54(2):274–276

    Article  CAS  PubMed  Google Scholar 

  • Petersson CJ, Redlund-Johnell I (1984) The subacromial space in normal shoulder radiographs. Acta Orthop Scand 55:57–58

    Article  CAS  PubMed  Google Scholar 

  • Porter NA, Singh J, Tins BJ, Lalam RK, Tyrrell PNM, Cassar-Pullicino VN (2015) A new method for measurement of subcoracoid outlet and its relationship to rotator cuff pathology at MR arthrography. Skeletal Radiol. 44(9):1309–1316

    Article  CAS  PubMed  Google Scholar 

  • Prato N, Peloso D, Franconeri A, Tegaldo G, Ravera GB, Silvestri E, Derchi LE (1998) The anterior tilt of the acromion: radiographic evaluation and correlation with shoulder diseases. Eur Radiol 8:1639–1646

    Article  CAS  PubMed  Google Scholar 

  • Randelli M, Gambrioli PL (1986) Glenohumeral osteometry by computed tomography in normal and unstable shoulders. Clin Orthop 208:151–156

    Google Scholar 

  • Richards DP, Burkhart SS, Campbell SE (2005) Relation between narrowed coracohumeral distance and subscapularis tears. Arthroscopy 21:1223–1228

    Article  PubMed  Google Scholar 

  • Roberts CS, Davila JN, Hushek SG, Tilett ED, Corrigan TM (2002) Magnetic resonance imaging analysis of the subacromial space in the impingement sign positions. J Shoulder Elb surg 11:595–599

    Article  Google Scholar 

  • Saupe N, Pfirrmann CWA, Schmid MR, Jost B, Werner CM, Zanetti M (2006) Association between rotator cuff abnormalities and reduced acromiohumeral distance. AJR 187:376–382

    Article  PubMed  Google Scholar 

  • Sluming VA (1995) Technical note: measuring the coracoclavicular distance with ultrasound—a new technique. Br J Radiol 68:189–193

    Article  CAS  PubMed  Google Scholar 

  • Stehle J, Moore SM, Alaseirlis DA, Debski RF, McMahon PJ (2007) Acromial morphology: effects of suboptimal radiographs. J Shoulder Elb Surg 16:135–142

    Article  Google Scholar 

  • Takase K, Yamamoto K, Imakiire A, Burkhead WZ Jr (2004) The radiographic study in the relationship of the glenohumeral joint. J Orthop Res 22:298–305

    Article  PubMed  Google Scholar 

  • Tétrault P, Krueger A, Zurakowski D, Gerber C (2004) Glenoid version and rotator cuff tears. J Orthop Res 22:202–207

    Article  Google Scholar 

  • Toivonen DA, Tuite MJ, Orwin JF (1995) Acromial structure and tears of the rotator cuff. J Shoulder Elb Surg 4:376–383

    Article  CAS  Google Scholar 

  • Tokgoz N, Kanatli U et al (2007) The relationship of glenoid and humeral version with supraspinatus tendon tears. Skelet Radiol 36:509–514

    Article  Google Scholar 

  • Torrens C, Lopez J, Puente I, Caceres E (2007) The influence of the acromial coverage index in rotator cuff rears. J Shoulder Elbow Surg 16:347–351

    Article  PubMed  Google Scholar 

  • Totty P, Proust F, Bertrand P, Fouquet B, Rosset P, Alison D, Valat JP, Rouleau P, Laffont J (1988) Rupture de la coiffe des rotateurs. Quantification des signes indirects en radiologie standard et manouevre de Leclercq. J Radiol 69:633–638

    Google Scholar 

  • Tuite MJ, Toivonen DA, Orwin JF, Wright DH (1995) Acromial angle on radiographs of the shoulder: correlation with the impingement syndrome and rotator cuff tears. Am J Roentgenol 165:609–613

    Article  CAS  Google Scholar 

  • Viehofer AF, Gerber C, Favre P, Bachmann E, Snedeker JG (2016a) A larger critical shoulder angle requires more rotator cuff activity to preserve joint stability. J Orthop Res 34:961–968

    Article  PubMed  Google Scholar 

  • Viehofer AF, Snedeker JG, Baumgartner D, Gerber C (2016b) Glenohumeral joint reaction forces increase with critical shoulder angles representative of osteoarthritis—a biomechanical analysis. J Orthop Res 34:1047–1052

    Article  PubMed  Google Scholar 

  • Wang JC, Shapiro MS (1997) Changes in acromial morphology with age. J Shoulder Elbow Surg 6:55–59

    Article  CAS  PubMed  Google Scholar 

  • Weiner DS, Macnab I (1970) Superior migration of the humeral head: a radiological aid in the diagnosis of tears of the rotator cuff. J Bone Joint Surg 52:524–527

    Article  CAS  Google Scholar 

  • Wuh HCK, Snyder SJ (1992) A modified classification of the supraspinatus outlet view based on the configuration and anatomical thickness of the acromion. Orthop Trans 16:767

    Google Scholar 

  • Yamamoto N, Itoi E, Abe H, Kikuchi K, Seki N, Minagawa H, Tuoheti Y (2009) Effect of an anterior glenoid defect on anterior shoulder instability: a cadaveric study. Am J Sports Med 37:949–954

    Article  PubMed  Google Scholar 

  • Yamamoto N, Muraki N, Sperling JW, Steinmann SP, Cofield RH, Itoi E, An KN (2010) Stabilising mechanism in bone grafting of a large glenoid defect. J Bone Joint Surg (Am) 92:2059–2066

    Article  Google Scholar 

  • Zuckerman JD, Kummer FJ, Cuomo F, Simon J, Rosenblum S, Katz N (1992) The influence of the coraco-acromial arch anatomy on rotator cuff tears. J Shoulder Elbow Surg 1:4–14

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, ASL BARI, 70100, Bari, Italy

    Fabio Martino M.D.

  2. University of Bari, 70100, Bari, Italy

    Michele Solarino M.D.

  3. Radiology Department of the P.O., “Di Venere” - ASL BARI, Bari, Italy

    Gianluigi Martino M.D.

  4. Department of Radiology, University of L’Aquila, 67100, L’Aquila, Italy

    Antonio Barile M.D. & Maria Vittoria Di Fabio M.D.

Authors
  1. Fabio Martino M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michele Solarino M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antonio Barile M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Vittoria Di Fabio M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gianluigi Martino M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabio Martino M.D. .

Editor information

Editors and Affiliations

  1. Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK

    Victor N. Cassar-Pullicino

  2. Department of Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK

    A. Mark Davies

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer-Verlag GmbH Germany, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Martino, F., Solarino, M., Barile, A., Di Fabio, M.V., Martino, G. (2020). Shoulder. In: Cassar-Pullicino, V., Davies, A. (eds) Measurements in Musculoskeletal Radiology. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-68897-6_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-68897-6_8

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-43853-3

  • Online ISBN: 978-3-540-68897-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation