Shoulder surgeons have been busy measuring angles on images of patients with and without rotator cuff disease. Here are eight examples where the authors have found higher rates of cuff disease when the measured angle is above or below a certain value:
Critical shoulder angle >35 degrees (see this link)
Greater tuberosity angle >70 degrees (see this link)
Acromial angle > 25 degrees (see this link)
Lateral acromial angle < 70 degrees (see this link)
Superior glenoid inclination angle > 9 degrees (see this link)
Acromial arch angle > 120 degrees (see this link)
Acromiohumeral centre edge angle >20 (see this link)
Decreased coracoid inclination angle (see this link)
A few questions arise about these measurements (see this link):
(1) What is their clinical utility, i.e. in this era of high quality MRI and ultrasound do these measurements affect clinical decision making?
(2) Do differences in these angles between shoulders with and without cuff disease suggest that the morphology reflected by the angle caused the cuff problem or is it likely that the cuff problem caused the morphology reflected by the angle?
(3) While it can be accomplished (see this link) is there evidence that surgically modifying these angles will change either the likelihood of subsequent cuff disease or the outcome of cuff repair surgery?
(4) Do these measurements matter? Contrast "Large Critical Shoulder Angle Has Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair" with "Critical Shoulder Angle and Acromial Index Do Not Influence 24-Month Functional Outcome After Arthroscopic Rotator Cuff Repair"
In our practice, we do not find that these measurements are of value in the treatment of our patients. The facts remain that
(1) Older patients with atraumatic cuff tears are less likely to benefit from rotator cuff repair surgery than their younger counterparts with traumatic cuff tears.
(2) Shoulders with inadequate cuff tendon quantity and quality have less chance of being durably reparable.
(3) The literature does not provide evidence that modifying the acromion is an important aspect of the treatment of cuff disease (see this link).
(4) Irreparable cuff tears in shoulders with retained active elevation can be well treated with a smooth and move procedure (see this link).
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