- Discussion:
- normally no communication exists between the shoulder joint and the subacromial bursae;
- when radiopaque dye is injected into the shoulder and is subsequently demonstrated in the subacromial bursa, a rotator cuff tear is present;
- Indications:
- for dx of complete rotator cuff tears, adhesive capsulitis, tear of the rotator interval, and disorders of the biceps tendon;
- impingement syndrome unresponsive to non surgical rx for 12 wks in patients more than 40 years old;
- rotator cuff tear:
- dye which appears simultaneously in joint & bursa is diagnostic for a tear;
- arthrography (for complete rotator cuff tears) has accuracy of > 90 - 95 %.
- in the study by Gartsman et al, 19 out of 24 patients w/ RCT, had a positive arthrogram;
- arthrography is of little value for detection of partial tears involving superior (bursal) surface of the rotator cuff or intra-tendinous tears;
- adhesive capsulitis:
- diminished joint capacity ( < 10 ml) & loss of axillary fold
- rotator interval tears:
- may mimic rotator cuff tears;
- impingment signs may be present along w/ biceps tendon tenderness;
- may allow extravasation of dye into subacromial space, as well as the subscapularis fossa (w/ dye seen anterior to the subscapularis);
- leakage into the subscapularis fossa may require shoulder movement;
- Technique:
- posterior portal:
- using the standard posterior portal position, insert 20 cc of saline into the joint thru a long spinal needle, and then remove the syringe, leaving the needle;
- if fluid drips out of the needle, then the needle is definately in the joint;
- anterior portal:
- local anesthetic is infiltrated into the skin and subcutaneous tissue, down to and including the anterior shoulder capsule;
- landmark is point just lateral to the tip of coracoid process;
- 15 mm of mixture of contrast fluid and lidocaine (ratio 3:1)
The joint side tear of the rotator cuff. A followup study by arthrography.