In vivo measurement of subacromial space width during shoulder elevation: technique and preliminary results in patients following unilateral rotator cuff repair.

BACKGROUND

The shoulder's subacromial space is of significant clinical interest due to its association with rotator cuff disease. Previous studies have estimated the subacromial space width to be 2-17 mm, but no study has measured in vivo subacromial space width during shoulder motion. The purpose of this study was to measure the in vivo subacromial space width during shoulder elevation in patients following rotator cuff repair.

METHODS

Biplane X-ray images were collected during shoulder elevation of 11 patients who had undergone rotator cuff repair. Glenohumeral joint motion was measured from the biplane X-ray images for each subject's repaired and asymptomatic, contralateral shoulders. The joint motion data were combined with subject-specific CT models to measure the subacromial space width during shoulder motion.

FINDINGS

Subacromial space width decreased with shoulder elevation, ranging from 2.3 to 7.4 mm in the repaired shoulder and 1.2-7.1 mm in the contralateral shoulder. Subacromial space width in the repaired shoulder was only 0.5 mm less than the contralateral shoulder when averaged over 10-60 degrees of glenohumeral elevation.

INTERPRETATION

The results indicate that the humerus in the repaired shoulder is positioned more cranially on the glenoid than in the contralateral shoulder. It is unclear if these subtle differences in subacromial space width are due to the surgical procedure or post-operative stiffness, or if subacromial impingement contributed to the development of the rotator cuff tear. Future research will ascertain if these results represent a transient response to the surgery or a more fundamental difference in rotator cuff function between repaired and contralateral shoulders.