A lower critical coracoid process angle is associated with type-B osteoarthritis: a radiological study of normal and diseased shoulders
Background: Degenerative rotator cuff tears and osteoarthritis (OA) are associated with differences in coronal plane scapular morphology, with particular focus on the effect of the critical shoulder angle (CSA) on shoulder biomechanics. The effect, if any, of axial plane scapular morphology is less...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-05-01
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| Series: | JSES International |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666638321002462 |
| _version_ | 1811289450084302848 |
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| author | William Wynell-Mayow, MRCS Chung Chi Chong Omar Musbahi, MRCS Edward Ibrahim, FRCS (Tr&Orth) |
| author_facet | William Wynell-Mayow, MRCS Chung Chi Chong Omar Musbahi, MRCS Edward Ibrahim, FRCS (Tr&Orth) |
| author_sort | William Wynell-Mayow, MRCS |
| collection | DOAJ |
| description | Background: Degenerative rotator cuff tears and osteoarthritis (OA) are associated with differences in coronal plane scapular morphology, with particular focus on the effect of the critical shoulder angle (CSA) on shoulder biomechanics. The effect, if any, of axial plane scapular morphology is less well established. We have noticed wide disparity of axial coracoid tip position in relation to the face of the glenoid and sought to investigate the significance of this through measurement of the critical coracoid process angle (CCPA), which incorporates coracoid tip position and glenoid version. Methods: CCPA, CSA, and glenoid retroversion were measured by three independent reviewers from the cross-sectional two-dimensional computed tomography (CT) and magnetic resonance imaging of 160 patients in four equal and matched case-control groups: (1) a control group of patients with a radiologically normal shoulder and no history of shoulder symptoms who had a CT thorax for another reason, (2) patients with primary OA with Walch type-A glenoid wear pattern on CT scan, (3) patients with type-B glenoid primary OA, and (4) patients with magnetic resonance imaging–proven atraumatic tears of the posterosuperior rotator cuff. Results: Interobserver agreement was excellent for all measured parameters. The median CCPA was significantly lower in the type-B OA group (9.3˚) than that in controls (18.7˚), but not significantly different in the other study groups. There was a trend toward greater glenoid retroversion in the type-B OA group, but receiver operating characteristic curve analysis demonstrated the CCPA to be by far the most powerful discriminator for type-B OA. The optimal cutoff value was calculated for the CCPA at 14.3˚ with a sensitivity of 93% and specificity of 90% for type-B OA. Compared with controls, the CSA was significantly higher in the rotator cuff tear group and lower in both OA groups, but did not differentiate between type-A and type-B OA. Conclusion: Combined with a lower CSA, a lower CCPA (<14.3˚) is strongly predictive of type-B glenoid OA. The authors propose a simple model of pectoralis major biomechanics to explain the effect of this axial plane anatomical variation, which requires further investigation. |
| first_indexed | 2024-04-13T03:55:02Z |
| format | Article |
| id | doaj.art-e9686c90952c4901831478d8901c8265 |
| institution | Directory Open Access Journal |
| issn | 2666-6383 |
| language | English |
| last_indexed | 2024-04-13T03:55:02Z |
| publishDate | 2022-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JSES International |
| spelling | doaj.art-e9686c90952c4901831478d8901c82652022-12-22T03:03:41ZengElsevierJSES International2666-63832022-05-0163447453A lower critical coracoid process angle is associated with type-B osteoarthritis: a radiological study of normal and diseased shouldersWilliam Wynell-Mayow, MRCS0Chung Chi Chong1Omar Musbahi, MRCS2Edward Ibrahim, FRCS (Tr&Orth)3West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, Middlesex; Corresponding author: William Wynell-Mayow, MRCS, Flat 317, West Block, Forum Magnum Square, London, SE1 7GL.West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, MiddlesexWest Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, Middlesex; MSk Lab, White City Campus, Imperial College London, LondonWest Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, MiddlesexBackground: Degenerative rotator cuff tears and osteoarthritis (OA) are associated with differences in coronal plane scapular morphology, with particular focus on the effect of the critical shoulder angle (CSA) on shoulder biomechanics. The effect, if any, of axial plane scapular morphology is less well established. We have noticed wide disparity of axial coracoid tip position in relation to the face of the glenoid and sought to investigate the significance of this through measurement of the critical coracoid process angle (CCPA), which incorporates coracoid tip position and glenoid version. Methods: CCPA, CSA, and glenoid retroversion were measured by three independent reviewers from the cross-sectional two-dimensional computed tomography (CT) and magnetic resonance imaging of 160 patients in four equal and matched case-control groups: (1) a control group of patients with a radiologically normal shoulder and no history of shoulder symptoms who had a CT thorax for another reason, (2) patients with primary OA with Walch type-A glenoid wear pattern on CT scan, (3) patients with type-B glenoid primary OA, and (4) patients with magnetic resonance imaging–proven atraumatic tears of the posterosuperior rotator cuff. Results: Interobserver agreement was excellent for all measured parameters. The median CCPA was significantly lower in the type-B OA group (9.3˚) than that in controls (18.7˚), but not significantly different in the other study groups. There was a trend toward greater glenoid retroversion in the type-B OA group, but receiver operating characteristic curve analysis demonstrated the CCPA to be by far the most powerful discriminator for type-B OA. The optimal cutoff value was calculated for the CCPA at 14.3˚ with a sensitivity of 93% and specificity of 90% for type-B OA. Compared with controls, the CSA was significantly higher in the rotator cuff tear group and lower in both OA groups, but did not differentiate between type-A and type-B OA. Conclusion: Combined with a lower CSA, a lower CCPA (<14.3˚) is strongly predictive of type-B glenoid OA. The authors propose a simple model of pectoralis major biomechanics to explain the effect of this axial plane anatomical variation, which requires further investigation.http://www.sciencedirect.com/science/article/pii/S2666638321002462Shoulder anatomyCritical shoulder angleCritical coracoid process angleGlenohumeral osteoarthritisScapular morphologyGlenoid wear |
| spellingShingle | William Wynell-Mayow, MRCS Chung Chi Chong Omar Musbahi, MRCS Edward Ibrahim, FRCS (Tr&Orth) A lower critical coracoid process angle is associated with type-B osteoarthritis: a radiological study of normal and diseased shoulders JSES International Shoulder anatomy Critical shoulder angle Critical coracoid process angle Glenohumeral osteoarthritis Scapular morphology Glenoid wear |
| title | A lower critical coracoid process angle is associated with type-B osteoarthritis: a radiological study of normal and diseased shoulders |
| title_full | A lower critical coracoid process angle is associated with type-B osteoarthritis: a radiological study of normal and diseased shoulders |
| title_fullStr | A lower critical coracoid process angle is associated with type-B osteoarthritis: a radiological study of normal and diseased shoulders |
| title_full_unstemmed | A lower critical coracoid process angle is associated with type-B osteoarthritis: a radiological study of normal and diseased shoulders |
| title_short | A lower critical coracoid process angle is associated with type-B osteoarthritis: a radiological study of normal and diseased shoulders |
| title_sort | lower critical coracoid process angle is associated with type b osteoarthritis a radiological study of normal and diseased shoulders |
| topic | Shoulder anatomy Critical shoulder angle Critical coracoid process angle Glenohumeral osteoarthritis Scapular morphology Glenoid wear |
| url | http://www.sciencedirect.com/science/article/pii/S2666638321002462 |
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