Plain radiographs can provide indirect information regarding the integrity of the rotator cuff. On the AP view in the plane of the scapula, an acromiohumeral interval of less than 6 mm indicates thinning of the supraspinatus tendon. This is because the thickness of the normal supraspinatus tendon between the humeral head and acromion is about 6 mm.
Acromiohumeral contact indicates that the superior cuff tendon cannot be intact.
Imaging of the rotator cuff tendons can be used to confirm the diagnosis of cuff tear, to establish the extent of the tear, and to evaluate the degree of tendon retraction.
In many cases these determinations can be made from the clinical history and the examination. MRI or expert dynamic sonography are now the gold standards for cuff tear imaging, replacing arthrography. Recently, the advent of surgeon-performed in-office sonography has provided a real-time opportunity for integration of cuff imaging with the physical examination as well as the opportunity to demonstrate the pathology to the patient.
Shoulder ultrasounds showing a 50% and a 95% thickness tears are shown below, emphasizing that tears usually start on the articular and not the acromial side of the tendon.
An MRI showing an articular sided partial tear is shown below.
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