Critical Shoulder Angle Assessment in Radiographies and Magnetic Resonance Imaging (MRI): Measurement of Intra and Inter-Observer Agreement

Main Article Content

José Carlos Souza Vilela, MD, PHD Anna Luiza Amancio Vidal Mabelly Andrade Correa Luciene Mota de Andrade Paulo Henrique Sampaio Ribeiro Bruno Biller Teixeira Fernandes de Araúj Tadeu Fonseca Barbosa Thalles Leandro Abreu Machado

Abstract

Objective: to evaluate the critical shoulder angle by comparing the results of measurements performed by radiography and magnetic resonance imaging, considering the intra and interobserver perspectives.


Methods: we evaluated radiographic and magnetic resonance images of 74 shoulders (71 patients) submitted to these exams between 2017 and 2020, regardless of the acquired pathology. We ran a statistical analysis comparing the mean values of the data obtained by the student's t-test, and the analysis of intra and interobserver agreement used the Interclass Correlation Coefficient (ICC), with bidirectional mixed models and a confidence interval of 95%.


Results: the patients had a mean age of 51.7 years, with a predominance of men (51.9%) and the most affected shoulder was the right-sided one (57.9%). There were no significant differences between the measurements made by radiography and those by magnetic resonance, both by intra and interobserver views, and the ICC showed a satisfactory level of agreement in relation to these aspects. Conclusion: there was an excellent degree of agreement between the examiners, in all the situations compared (intra and interobserver, radiography and MRI), considering the two periods of analysis.

Keywords: Critical Shoulder Angle, X-ray, Magnetic Resonance Imaging

Article Details

How to Cite
SOUZA VILELA, José Carlos et al. Critical Shoulder Angle Assessment in Radiographies and Magnetic Resonance Imaging (MRI): Measurement of Intra and Inter-Observer Agreement. Medical Research Archives, [S.l.], v. 10, n. 4, apr. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2750>. Date accessed: 21 nov. 2024. doi: https://doi.org/10.18103/mra.v10i4.2750.
Section
Research Articles

References

1. Souza MC, Jorge RT, Jones A, Lombardi Júnior I, Natour J. Progressive resistance training in patients with shoulder impingement syndrome: literature review. Reumatismo, 2009;61(2):84-9.
2. Brennan GP, Prent EC, Cleland JA. Description of clinical outcomes and postoperative utilization of physical therapy services within 4 categories of shoulder surgery. J Orthop Sports Phys Ther. 2010;40(1):20-9.
3. Watson J, Helliwell P, Morton V, Adebajo A, Dickson J, Russel I, Torgerson D. Shoulder acute pain in primary healthcare: is retraining effective for GP principals? SAPPHIRE: a randomized controlled trial. Rheumatology (Oxford), 2008;47(12):1795-1802.
4. Feitosa ALM, Silva CC. Prevalência das síndromes dolorosas do ombro em pacientes atendidos em uma clínica privada de fisioterapia em Teresina – PI. Rev. Saúde em Foco, 2015;2(1):12-24.
5. Matthews TJW, Hand GC, Rees JL, Athanasou NA, Carr AJ. Pathology of the torn rotator cuff tendon. Reduction in potential for repair as tear size increases. J Bone Joint Surg Br. 2006;88(4):489-95.
6. Tétreault P, Krueger A, Zurakowski D, Gerber C. Glenoid version and rotator cuff tears. J Orthop Res Off Publ Orthop Res Soc. 2004;22(1):202-7.
7. Bhatia DN, Debeer JF, Toit DF du. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. 2006;88(8):1889-90.
8. Nyffeler RW, Werner CML, Sukthankar A, Schmid MR, Geber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. 2006;88(4):800-5.
9. Gerber C, Snedeker JG, Baumgartner D, Viehöfer AF. Supraspinatus tendon load during abduction is dependent on the size of the critical shoulder angle: a biomechanical analysis. J Orthop Res Off Publ Orthop Res Soc. 2014;32(7):952-7.
10. Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint?: a radiological study of the critical shoulder angle. Bone Joint J. 2013;95-B(7):935-41.
11. Li H, Chen Y, Chen J, Hua Y, Chen S. Large critical shoulder angle has higher risk of tendon retear after arthroscopic rotator cuff repair. Am J Sports Med. 2018;46(8):1892-1900.
12. Balke M, Liem D, Greshake O, Hoeher J, Bouillon B, Banerjee M. Differences in acromial morphology of shoulders in patients with degenerative and traumatic supraspinatus tendon tears. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2016;24(7):2200-5.
13. Daggett M, Werner B, Collin P, Gauci M-O, Chaoui J, Walch G. Correlation between glenoid inclination and critical shoulder angle: a radiographic and computed tomography study. J Shoulder Elbow Surg. 2015;24(12):1948-53.
14. Heuberer PR, Plachel F, Willinger L, Moroder P, Laky B, Pauzenberger L, Lomoschitz F, Ander W. Critical shoulder angle combined with age predict five shoulder pathologies: a retrospective analysis of 1000 cases. BMC Musculoskelet Disord. 2017;18(259):1-9.
15. Kim JR, Ryu KJ, Hong IT, Kim BK, Kim JH. Can a high acromion index predict rotator cuff tears? Int Orthop. 2012;36(5):1019-24.
16. Moor BK, Wieser K, Slankamenac K, Gerber C, Bouaicha S. Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elbow Surg. 2014;23(4):536-41.
17. Pandey V, Vijayan D, Tapashetti S, Agarwal L, Kamath A, Acharya K, Maddukuri S, Willems WJ. Does scapular morphology affect the integrity of the rotator cuff? J Shoulder Elbow Surg. 2016;25(3):413-21.
18. Spiegl UJ, Horan MP, Smith SW, Ho CP, Millett PJ. The critical shoulder angle is associated with rotator cuff tears and shoulder osteoarthritis and is better assessed with radiographs over MRI. Knee Surg Sports Traumatol Arthrosc. 2016;24(7):2244-51.
19. Gomide LC, Carmo TC, Bergo GHM, Oliveira GA, Macedo IS. Associação entre o ângulo crítico do ombro e lesão do manguito rotador: um estudo epidemiológico retrospectivo. Rev Bras Ortop. 2017;52(4):423-7.
20. Bjarnison AO, Sorensen TJ, Kallemose T, Barfod KW. The critical shoulder angle is associated with osteoarthritis in the shoulder but not rotator cuff tears: a retrospective case-control study. J Shoulder Elbow Surg. 2017;26(12):2097-102.
21. Bishop JL, Kline SK, Aalderink KJ, Zauel R, Bey MJ. Glenoid inclination: in vivo measures in rotator cuff tear patients and associations with superior glenohumeral joint translation. J Shoulder Elbow Surg. 2009;18(2):231–6.
22. Suter T, Popp AG, Zhang Y, Zhang C, Tashjian RZ, Henninger HB. The influence of radiographic viewing perspective and demographics on the critical shoulder angle. J Shoulder Elbow Surg. 2015;24(6):149-58.
23. Lopes ACB, Leinioski AC, Ceccon L. Testes t para comparação de médias de dois grupos independentes. Curitiba: UFPR; 2015.
24. Li X, Olszewski N, Abdul-Rassoul H, Curry EJ, Galvin JW, Eichinger JK. Relationship between the critical shoulder angle and shoulder disease. JBJS Reviews, 2018;6(8):1-8.
25. Garcia JC, Altoe LS, Amaral RFM, Aihaea AY, Lutfi HV, Mello MBD. Estudo duplo-cego randomizado da correlação entre radiografia simples e ressonância magnética na avaliação do ângulo crítico do ombro: reprodutibilidade e curva de aprendizado. Rev Bras Ortop. [online]. 2020. DOI: 10.1055/s-0040-1701288.