Skip to main content
Top
Published in: European Journal of Orthopaedic Surgery & Traumatology 2/2013

01-02-2013 | Original Article

Observer variability in the assessment of the acromiohumeral interval using anteroposterior shoulder radiographs

Authors: G. A. Bernhardt, M. Glehr, M. Zacherl, C. Wurnig, G. Gruber

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 2/2013

Login to get access

Abstract

Background

An acromiohumeral interval narrower than 6 mm measured on AP shoulder radiographs has been considered pathological and suggestive of rotator cuff tears. This prospective study was conducted to assess inter- and intraobserver variation in the radiographic assessment of the acromiohumeral interval and its critical value on routinely taken AP shoulder radiographs off-study use to evaluate the accuracy of this measurement method.

Methods

The acromiohumeral distance from the inferior anterior acromial aspect to the humeral head was measured in millimeters. Thirty blinded, anteroposterior shoulder radiographs were independently reviewed by five board-certified orthopedic shoulder surgeons at two time points in random order.

Results

The results of three investigators showed significant intraobserver variation. Five investigator pairs showed significant interobserver variation at both examination time points. The maximum interobserver difference for the same radiograph was 8 mm (range 0 to 8 mm).

Conclusion

Our results indicate that the assessment of the acromiohumeral interval using non-standardized anteroposterior radiographs off-study use cannot be seen as a reproducible and reliable method of measurement.
Literature
1.
go back to reference Saupe N, Pfirrmann CWA, Schmid MR, Jost B, Werner CML, Zanetti M (2006) Association between rotator cuff abnormalities and reduced acromiohumeral distance. Am J Roentgenol 187:376–382CrossRef Saupe N, Pfirrmann CWA, Schmid MR, Jost B, Werner CML, Zanetti M (2006) Association between rotator cuff abnormalities and reduced acromiohumeral distance. Am J Roentgenol 187:376–382CrossRef
2.
go back to reference Pijls BG, Kok FP, Penning LIF, Guldemond NA, Arens HJ (2009) Reliability study of the sonographic measurement of the acromiohumeral distance in symptomatic patients. J Clin Ultrasound 38:128–134 Pijls BG, Kok FP, Penning LIF, Guldemond NA, Arens HJ (2009) Reliability study of the sonographic measurement of the acromiohumeral distance in symptomatic patients. J Clin Ultrasound 38:128–134
3.
go back to reference Seitz AL, Michener LA (2011) Ultrasonographic measures of subacromial space in patients with rotator cuff disease: a systematic review. J Clin Ultrasound 39:146–154PubMedCrossRef Seitz AL, Michener LA (2011) Ultrasonographic measures of subacromial space in patients with rotator cuff disease: a systematic review. J Clin Ultrasound 39:146–154PubMedCrossRef
4.
go back to reference Van de Sande MAJ, Rozing PM (2006) Proximal migration can be measured accurately on standardized anteroposterior shoulder radiographs. Clin Orthop Relat Res 443:260–265PubMedCrossRef Van de Sande MAJ, Rozing PM (2006) Proximal migration can be measured accurately on standardized anteroposterior shoulder radiographs. Clin Orthop Relat Res 443:260–265PubMedCrossRef
5.
go back to reference Graichen H, Bonel H, Stammberger T, Haubner M, Rohrer H, Englmeier KH, Reiser M, Eckstein F (1999) Three-dimensional analysis of the width of the subacromial space in healthy subjects and patients with impingement syndrome. Am J Roentgenol 172:1081–1086 Graichen H, Bonel H, Stammberger T, Haubner M, Rohrer H, Englmeier KH, Reiser M, Eckstein F (1999) Three-dimensional analysis of the width of the subacromial space in healthy subjects and patients with impingement syndrome. Am J Roentgenol 172:1081–1086
6.
go back to reference Railhac JJ, Sans N, Rigal A, Chiavassa H, Galy-Fourcade D, Richardi G, Assoun J, Bellumore Y, Mansat M (2001) Strict anteroposterior radiography of the shoulder: value of the assessment of rotator cuff tears. J Radiol 82:979–985PubMed Railhac JJ, Sans N, Rigal A, Chiavassa H, Galy-Fourcade D, Richardi G, Assoun J, Bellumore Y, Mansat M (2001) Strict anteroposterior radiography of the shoulder: value of the assessment of rotator cuff tears. J Radiol 82:979–985PubMed
7.
go back to reference Goud A, Segal D, Hedayati P, Pan JJ, Weissman BN (2008) Radiographic evaluation of the shoulder. Eur J Radiol 68:2–15PubMedCrossRef Goud A, Segal D, Hedayati P, Pan JJ, Weissman BN (2008) Radiographic evaluation of the shoulder. Eur J Radiol 68:2–15PubMedCrossRef
8.
go back to reference Denis A, Vial J, Sans N, Loustau O, Chiavassa-Gandois H, Railhac JJ (2008) Shoulder radiography: useful radiographic views in current practice. J Radiol 89:620–632PubMedCrossRef Denis A, Vial J, Sans N, Loustau O, Chiavassa-Gandois H, Railhac JJ (2008) Shoulder radiography: useful radiographic views in current practice. J Radiol 89:620–632PubMedCrossRef
9.
go back to reference Cotton RE, Rideout DF (1964) Tears of the humeral rotator cuff: a radiological and pathological necropsy survey. J Bone Joint Surg (Br) 46:314–328 Cotton RE, Rideout DF (1964) Tears of the humeral rotator cuff: a radiological and pathological necropsy survey. J Bone Joint Surg (Br) 46:314–328
10.
go back to reference Kotzen LM (1971) Roentgen diagnosis of rotator cuff tear: report of 48 surgically proven cases. Am J Roentgenol Radium Ther Nucl Med 112:507–511PubMed Kotzen LM (1971) Roentgen diagnosis of rotator cuff tear: report of 48 surgically proven cases. Am J Roentgenol Radium Ther Nucl Med 112:507–511PubMed
11.
go back to reference Petersson CJ, Redlund-Johnell I (1984) The subacromial space in normal shoulder radiographs. Acta Orthop Scand 55:57–58PubMedCrossRef Petersson CJ, Redlund-Johnell I (1984) The subacromial space in normal shoulder radiographs. Acta Orthop Scand 55:57–58PubMedCrossRef
12.
go back to reference Hardy D, Vogler JB 3rd, White RH (1986) The shoulder impingement syndrome: prevalence of radiographic findings and correlation with response to therapy. Am J Roentgenol 147:557–561 Hardy D, Vogler JB 3rd, White RH (1986) The shoulder impingement syndrome: prevalence of radiographic findings and correlation with response to therapy. Am J Roentgenol 147:557–561
13.
go back to reference Lehtinen JT, Belt EA, Lyback CO et al (2000) Subacromial space in the rheumatoid shoulder: a radiographic 15-year follow-up study of 148 shoulders. J Shoulder Elbow Surg 9:183–187PubMedCrossRef Lehtinen JT, Belt EA, Lyback CO et al (2000) Subacromial space in the rheumatoid shoulder: a radiographic 15-year follow-up study of 148 shoulders. J Shoulder Elbow Surg 9:183–187PubMedCrossRef
15.
go back to reference Gruber G, Bernhardt GA, Clar H, Zacherl M, Glehr M, Wurnig C (2009) Measurement of the acromiohumeral interval on standardized anteroposterior radiographs: a prospective study of observer variability. J Shoulder Elbow Surg 19:10–13CrossRef Gruber G, Bernhardt GA, Clar H, Zacherl M, Glehr M, Wurnig C (2009) Measurement of the acromiohumeral interval on standardized anteroposterior radiographs: a prospective study of observer variability. J Shoulder Elbow Surg 19:10–13CrossRef
16.
go back to reference Weiner D, Macnab I (1970) Superior migration of the humeral head: a radiological aid in the diagnosis of tears of the rotator cuff. J Bone Joint Surg (Br) 52:524–527 Weiner D, Macnab I (1970) Superior migration of the humeral head: a radiological aid in the diagnosis of tears of the rotator cuff. J Bone Joint Surg (Br) 52:524–527
17.
go back to reference Michener L, McClure PW, Karduna AR (2003) Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech 18:369–379CrossRef Michener L, McClure PW, Karduna AR (2003) Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech 18:369–379CrossRef
18.
go back to reference Hamada K, Fukuda H, Mikasa M et al (1990) Roentgenographic findings in massive rotator cuff tears: a long- term observation. Clin Orthop Relat Res 254:92–96PubMed Hamada K, Fukuda H, Mikasa M et al (1990) Roentgenographic findings in massive rotator cuff tears: a long- term observation. Clin Orthop Relat Res 254:92–96PubMed
19.
go back to reference Moosikasuwan JB, Miller TT, Burke BJ (2005) Rotator cuff tears: clinical, radiographic, and US findings. RadioGraphics 25:1591–1607PubMedCrossRef Moosikasuwan JB, Miller TT, Burke BJ (2005) Rotator cuff tears: clinical, radiographic, and US findings. RadioGraphics 25:1591–1607PubMedCrossRef
20.
go back to reference O’Regan D, Harvey CJ, Allen SD (2006) Interpretation of the shoulder radiograph. Br J Hosp Med 67:27–29 O’Regan D, Harvey CJ, Allen SD (2006) Interpretation of the shoulder radiograph. Br J Hosp Med 67:27–29
21.
go back to reference Van de Sande MA, Stoel BC, Rozing PM (2006) Subacromial space measurement: a reliable method indicating fatty infiltration in patients with rheumatoid arthritis. Clin Orthop Relat Res 451:73–79PubMedCrossRef Van de Sande MA, Stoel BC, Rozing PM (2006) Subacromial space measurement: a reliable method indicating fatty infiltration in patients with rheumatoid arthritis. Clin Orthop Relat Res 451:73–79PubMedCrossRef
22.
go back to reference Nové-Josserand L, Edwards TB, O’Connor DP et al (2005) The acromiohumeral and coracohumeral intervals are abnormal in rotator cuff tears with muscular fatty degeneration. Clin Orthop Relat Res 433:90–96PubMedCrossRef Nové-Josserand L, Edwards TB, O’Connor DP et al (2005) The acromiohumeral and coracohumeral intervals are abnormal in rotator cuff tears with muscular fatty degeneration. Clin Orthop Relat Res 433:90–96PubMedCrossRef
23.
go back to reference Nagels J, Verweij J, Stokdijk M et al (2008) Reliability of proximal migration measurements in shoulder arthroplasty. J Shoulder Elbow Surg 17:241–247PubMedCrossRef Nagels J, Verweij J, Stokdijk M et al (2008) Reliability of proximal migration measurements in shoulder arthroplasty. J Shoulder Elbow Surg 17:241–247PubMedCrossRef
24.
go back to reference Werner CM, Conrad SJ, Meyer DC et al (2008) Intermethod agreement and interobserver correlation of radiologic acromiohumeral distance measurements. J Shoulder Elbow Surg 17:237–240PubMedCrossRef Werner CM, Conrad SJ, Meyer DC et al (2008) Intermethod agreement and interobserver correlation of radiologic acromiohumeral distance measurements. J Shoulder Elbow Surg 17:237–240PubMedCrossRef
25.
go back to reference Fehringer EV, Rosipal CE, Rhodes DA et al (2008) The radiographic acromiohumeral interval is affected by arm and radiographic beam position. Skeletal Radiol 37:535–539PubMedCrossRef Fehringer EV, Rosipal CE, Rhodes DA et al (2008) The radiographic acromiohumeral interval is affected by arm and radiographic beam position. Skeletal Radiol 37:535–539PubMedCrossRef
26.
go back to reference Teefey SA, Rubin DA, Middleton WD et al (2004) Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg (Am) 86:708–716 Teefey SA, Rubin DA, Middleton WD et al (2004) Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg (Am) 86:708–716
27.
go back to reference Moosmayer S, Smith HJ (2005) Diagnostic ultrasound of the shoulder–a method for experts only? Results from an orthopedic surgeon with relative inexpensive compared to operative findings. Acta Orthop 76:503–508PubMedCrossRef Moosmayer S, Smith HJ (2005) Diagnostic ultrasound of the shoulder–a method for experts only? Results from an orthopedic surgeon with relative inexpensive compared to operative findings. Acta Orthop 76:503–508PubMedCrossRef
28.
go back to reference Mayerhoefer ME, Breitenseher MJ, Wurnig C, Roposch A (2009) Shoulder Impingement: relationship of clinical symptoms and imaging criteria. Clin J Sport Med 19:83–89PubMedCrossRef Mayerhoefer ME, Breitenseher MJ, Wurnig C, Roposch A (2009) Shoulder Impingement: relationship of clinical symptoms and imaging criteria. Clin J Sport Med 19:83–89PubMedCrossRef
Metadata
Title
Observer variability in the assessment of the acromiohumeral interval using anteroposterior shoulder radiographs
Authors
G. A. Bernhardt
M. Glehr
M. Zacherl
C. Wurnig
G. Gruber
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
European Journal of Orthopaedic Surgery & Traumatology / Issue 2/2013
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-012-0942-y

Other articles of this Issue 2/2013

European Journal of Orthopaedic Surgery & Traumatology 2/2013 Go to the issue