Benjamin L. Fritz MD, Presenter: Nothing to Disclose

Ara Kassarjian MD, Abstract Co-Author: Nothing to Disclose

Hugue Ouellette, Abstract Co-Author: Nothing to Disclose

William Ewing Palmer MD, Abstract Co-Author: Nothing to Disclose

To determine the relationship between rotator cuff lesions and locations of intraosseous cysts involving the greater tuberosity, and to test the hypothesis that anterior cysts correlate closely with supraspinatus tears.

In 52 patients (32 male, 20 female, ages 18-71) who underwent surgical evaluation of the rotator cuff, MR images were retrospectively reviewed to determine the location of cystic change in the greater tuberosity. Two reviewers reached consensus. Cyst was defined as a subcortical, rounded abnormality that measured at least 2mm, was visible in at least 2 imaging planes, and contained fluid or solid soft tissue. Cyst location was categorized as anterior if located at the supraspinatus attachment site, or posterior if located at the infraspinatus attachment site. Associated bone marrow edema was recorded. All MR images were acquired at 1.5T using dedicated shoulder coil and routine clinical protocol.

At surgery, 17 shoulders had complete rotator cuff tears, 11 had partial tears and 24 had no tear. Based on prospective reporting, preoperative MR studies showed 26 true-positive, 22 true-negative, 2 false-positive and 2 false-negative diagnoses resulting in a sensitivity of 93% and specificity of 92%. Greater tuberosity cysts occurred in 32/52 (62%) shoulders. In these shoulders, 30/32 (94%) had posterior cysts, 11/32 (34%) had anterior cysts and 9/32 (28%) had discrete cysts in both locations. Anterior cysts were closely correlated with cuff tears (P<.001). In one shoulder with proven cuff tear, anterior cyst was present although the tear was missed prospectively. Posterior cysts showed no relationship to cuff pathology or patient age. Bone marrow edema was more likely to involve anterior cysts than posterior cysts (P<.01).

Anterior cysts in the greater tuberosity are much less common than posterior cysts and correlate closely with rotator cuff tears. Posterior cysts are seen in all age groups, regardless of cuff pathology. In the absence of obvious rotator cuff tear, anterior cystic change should lead to closer scrutiny of the supraspinatus tendon for subtle evidence of tear.

Fritz, B, Kassarjian, A, Ouellette, H, Palmer, W, Correlation between Rotator Cuff Tear and the Location of Cystic Change Involving Greater Tuberosity.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4414765.html