Background: An acromiohumeral interval narrower than six millimeters has been considered pathologic and strongly indicative for rotator cuff tears by numerous authors. This prospective study was conducted as an assessment of inter- and intraobserver variation in the radiographic measurement of the acromiohumeral interval and its critical value.

Material and Methods: Thirty blinded, standardized anteroposterior shoulder radiographs were independently reviewed by five board certified orthopedic shoulder surgeons. The acromiohumeral distance, from the inferior anterior acromial aspect to the humeral head was measured in millimeters. The five investigators classified each film a second time in random order.

Results: Finally the same 27 radiographs (90%) have been evaluated by five investigators at both examination time points. The results of three investigators showed significant intra-observer variation ranging from 4 to 11 millimeters for the same radiograph. Six investigator pairs showed significant inter-observer variation at both examination time points (p< 0.05). The maximum inter-observer difference for the same radiograph was 11 millimeters (ranging from 1 to 11, SD 0.3 – 4.2).

Conclusion: In view of our results the assessment of the acromiohumeral interval using anteroposterior x-rays does not seem to be a reproducible method of measurement. Further investigations in combination with CT or MRI are necessary to ensure our findings.

Aims: Since several authors query the beneþt of surgical repair of rotator cuff tears, especially in the elderly patients, the purpose of our study was to observe patients with asymptomatic rotator cuff tears. Methods: A series of 235 patients were enrolled clinically during the time of hospitalization, additional ultrasound and X-ray examination of the shoulder was done. In 14 patients ultrasound revealed a clinical asymptomatic cuff tear, afþrmed by MR examination. All 14 patients were observed for 5 years with regular clinical and sonographic examination. Additional MRI was done at 5 year follow-up. Results: At the time of the last follow-up, only one patient developed speciþc symptoms, such as pain, nocturnal pain and weakness due to the cuff tear. Operative treatment for rotator cuff repair was scheduled. Active range of motion deceased from 180û to 167û in ßexion and from 178û to 165û in abduction. Also range of external and internal rotation decreased. Radiological aggravation of cuff arthropathy was observed in all cases. Conclusion: Results of this study suggest that a rotator cuff tear can remain asymptomatic for years, although radiological signs of osteoarthrosis increases.

The aim of this study was to evaluate how three different scoring systems (Constant, Reichelt, and UCLA scores) perform in individuals with normal shoulder function.

Scoring systems to evaluate the outcome of surgical treatment around the shoulder are well established. A total of 201 individuals were enrolled in this study. They were divided in four age groups and divided by sex: Group 1: Under 50 years of age: 25 female, 21 male; Group II: From 50 to 59 years of age: 17 female, 21 male; Group III: From 60 to 69 years of age: 18 female, 12 male; Group IV: 70 years of age and older: 24 female, 15 male.

All underwent clinical examination, ultrasound examination for detection of cuff tears, and radiograph examination in three planes. In all cases the dominant arm was enrolled. Twelve patients were excluded from the study because ultrasound depicted cuff tear or radiograph showed more than mild osteoarthritis according to the criteria of Hawkins, et al. (1990).

The main factor influencing the over-all score was the age-dependent decrease of muscle force measured in forward arm flexion (max. 12.5kp). The score was also influenced by the limitation of internal rotation (Group I: 13%, Group II: 26%, Group III: 40%, Group IV: 41%). According to the Reichelt and UCLA scores, males in Groups I, II and III reached a 100% top score in the UCLA and Reichelt scoring systems. In Group IV composed of older male patients, 20% scored less that the top score because of loss in active motion and muscle force. Only females in Groups I and II scored maximum results. Females in Group III scored 11% and in Group IV composed of older female patients, 50% scored less than the top score because of loss in active motion and muscle force.

Due to the natural aging process, males and females in Group IV could not accomplish maximum scores. We recommend that the top scores for the oldest age group be adjusted in order to avoid drawing erroneous conclusions from the scores in this age group.

The purpose of this study was to evaluate if there was a difference in the outcome of operative treatment for rotator cuff-tears in patients younger and older than the age of 60.

Thirty-eight patients (19 male, 19 female) underwent 40 procedures and were postoperatively evaluated 15 and 42 months after surgery. At the time of follow-up they had a physical examination that included the Constant score, radiograph in three planes and a questionnaire focused on the need for analgesics, nocturnal pain, and return to full activity (work and sports). Cuff tears were classified by the Harryman classification. Corresponding to the study design, patients were divided into two age groups: under the age of sixty years (51a, min. 44a, max. 58a, n=22) and patients sixty years of age and older (68,3a, min. 60a, max. 82a, n=16).

Active range of motion increased significantly in both age groups (p< 0.05) from 101° to 152° in abduction after the first 15 months after surgery and in anteversion from 117° to 155°. By the time of the second evaluation, abduction had decreased to 136° for abduction and 149° for anteversion. The results of functional assessment by the Constant score was 72 points after 16 months and after 42 months decreasing to 62 points in the group of patients under the age of 60, and from 71 to 66 points in the group of patients 60 years of age and older.

In both age groups there was a continuous increase in muscle force: from 4.35kp after 15 months to 4.5kp after 42 months in patients younger than 60, and from 2.24kp to 3.75kp in the older age group. Pain and the use of analgesic medication decreased significantly (p< 0.0001 and p=0.0003) in both age groups during the first 15 months after surgery and after 42 months had remained at the same low level. There was a correlation between extent of the cuff tear and results of functional assessment by the constant score. For patients with Harryman Type I cuff tears, mean score after 15 months was 78 points decreasing to a mean score of 65 points after 42 months. Harryman Type II cuff tears decreased from 74 to 70 points, with Type III cuff tears decreasing from 63 to 57 points.

Patients in the age group of 60 years and older had more similar benefits from operative treatment for rotator cuff-tears than the group under the age of 60. The best clinical result in both groups appeared during the first two years after surgery and decreased an average of 3.5 years postoperatively. The results of the Constant Score were influenced primarily by the size of the cuff tear.