Diagnostic Value of Acromiohumeral Distance in Rotator Cuff Pathology: Implications for Advanced-Practice Physiotherapists

Author:

Razmjou Helen123,Palinkas Veronica13,Christakis Monique45,Kennedy Deborah136,Robarts Susan123

Affiliation:

1. Department of Rehabilitation, Holland Orthopaedic & Arthritic Centre;

2. Sunnybrook Research Institute;

3. Department of Physical Therapy;

4. Department of Medical Imaging, Sunnybrook Health Sciences Centre;

5. Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto;

6. School of Rehabilitation Science, McMaster University, Hamilton, Ont.

Abstract

Purpose: The primary purpose of this study was to examine the inter-tester reliability and criterion validity of reduced acromiohumeral distance (AHD; <6 mm) visualized on plain radiographs in detecting rotator cuff (RC) pathology. The secondary objective was to examine the relationship between this radiographic feature and patient demographics and clinical examination. Method: This was a diagnostic study of patients seen in a tertiary care centre. Two advanced-practice physiotherapists measured AHD in two radiographic views. MRI was used as the gold standard. Results: A total of 150 consecutive patients (mean age 59 [SD 11] y, 57 women, 93 men) were included. AHD less than 6 millimetres was highly specific in both views for the presence of tear (99%), tear size (96%–98%), and fatty infiltration in the supraspinatus and infraspinatus muscles (93%–96%). The absence of AHD less than 6 millimetres was associated with a lack of advanced fatty infiltration in the supraspinatus and infraspinatus muscles (92%–100%). Sensitivity values were low for the presence and size of RC tear (21%–55%). We found a statistically significant positive association between the AHD categories and clinically observed muscle wasting and weakness of the RC muscles ( p < 0.05). Conclusions: AHD less than 6 millimetres was reliably measured in plain radiographs and was strongly associated with important clinical and imaging features of advanced RC pathology; this may assist with clinical decision making by allowing judicious use of more costly investigations and referral for surgery.

Publisher

University of Toronto Press Inc. (UTPress)

Subject

Physical Therapy, Sports Therapy and Rehabilitation

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