Abstract
The critical shoulder angle (CSA) constitutes a straightforward and highly reproducible tool. Degenerative rotator cuff tears (RCT) are associated with a significantly larger CSA. In this review, the most relevant features of the CSA are summarized: (1) the relationship between the CSA and RCT pathophysiology, (2) accurate measurement of the CSA according to various imaging modalities, (3) the contribution of the CSA in predicting the occurrence of RCT, and (4) RCT recurrence after surgical repair.
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Murphy RJ, Carr AJ. Shoulder pain. BMJ Clin Evid [Internet]. 2010 Jul 22 [cited 2018 Sep 14];2010. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217726/.
Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med. 2012;31(4):589–604.
Nyffeler RW, Meyer DC. Acromion and glenoid shape: why are they important predictive factors for the future of our shoulders? EFORT Open Rev. 2017;2(5):141–50.
Nyffeler RW, Werner CML, Sukthankar A, Schmid MR, Gerber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. 2006;88(4):800–5.
Pesquer L, Borghol S, Meyer P, Ropars M, Dallaudière B, Abadie P. Multimodality imaging of subacromial impingement syndrome. Skelet Radiol. 2018;47(7):923–37.
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 Jt J. 2013;95–B(7):935–41.
Hughes RE, Bryant CR, Hall JM, Wening J, Huston LJ, Kuhn JE, et al. Glenoid inclination is associated with full-thickness rotator cuff tears. Clin Orthop. 2003;407:86–91.
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.
Moor BK, Kuster R, Osterhoff G, Baumgartner D, Werner CML, Zumstein MA, et al. Inclination-dependent changes of the critical shoulder angle significantly influence superior glenohumeral joint stability. Clin Biomech Bristol Avon. 2016;32:268–73.
Moor BK, Wieser K, Slankamenac K, Gerber C, Bouaicha S. Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elb Surg. 2014;23(4):536–41.
Bouaicha S, Ehrmann C, Slankamenac K, Regan WD, Moor BK. Comparison of the critical shoulder angle in radiographs and computed tomography. Skelet Radiol. 2014;43(8):1053–6.
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.
Blonna D, Giani A, Bellato E, Mattei L, Caló M, Rossi R, et al. Predominance of the critical shoulder angle in the pathogenesis of degenerative diseases of the shoulder. J Shoulder Elb Surg. 2016;25(8):1328–36.
Cherchi L, Ciornohac JF, Godet J, Clavert P, Kempf J-F. Critical shoulder angle: measurement reproducibility and correlation with rotator cuff tendon tears. Orthop Traumatol Surg Res OTSR. 2016;102(5):559–62.
Bjarnison AO, Sørensen 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 Elb Surg. 2017;26(12):2097–102.
Chalmers PN, Salazar D, Steger-May K, Chamberlain AM, Yamaguchi K, Keener JD. Does the critical shoulder angle correlate with rotator cuff tear progression? Clin Orthop. 2017;475(6):1608–17.
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 Elb Surg Am Shoulder Elb Surg Al. 2015;24(6):e149–58.
Kaiser D, Bachmann E, Gerber C, Meyer DC. Influence of the site of acromioplasty on reduction of the critical shoulder angle (CSA) – an anatomical study. BMC Musculoskelet Disord. 2018;19(1):371.
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.
Mantell MT, Nelson R, Lowe JT, Endrizzi DP, Jawa A. Critical shoulder angle is associated with full-thickness rotator cuff tears in patients with glenohumeral osteoarthritis. J Shoulder Elb Surg. 2017;26(12):e376–81.
Shinagawa K, Hatta T, Yamamoto N, Kawakami J, Shiota Y, Mineta M et al. Critical shoulder angle in an East Asian population: correlation to the incidence of rotator cuff tear and glenohumeral osteoarthritis. J Shoulder Elbow Surg. 2018;27(9):1602–06.
Heuberer PR, Plachel F, Willinger L, Moroder P, Laky B, Pauzenberger L, et al. Critical shoulder angle combined with age predict five shoulder pathologies: a retrospective analysis of 1000 cases. BMC Musculoskelet Disord [Internet]. 2017 Jun 15 [cited 2018 Jun 18];18. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472957/.
Dietrich TJ, Moor BK, Puskas GJ, Pfirrmann CWA, Hodler J, Peterson CK. Is the lateral extension of the acromion related to the outcome of shoulder injections? Eur Radiol. 2015;25(1):267–73.
Garcia GH, Liu JN, Degen RM, Johnson CC, Wong A, Dines DM, et al. Higher critical shoulder angle increases the risk of retear after rotator cuff repair. J Shoulder Elb Surg. 2017;26(2):241–5.
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):1892–900.
Ames JB, Horan MP, Van der Meijden OAJ, Leake MJ, Millett PJ. Association between acromial index and outcomes following arthroscopic repair of full-thickness rotator cuff tears. J Bone Joint Surg Am. 2012;94(20):1862–9.
Beeler S, Hasler A, Götschi T, Meyer DC, Gerber C. The critical shoulder angle: acromial coverage is more relevant than glenoid inclination. J Orthop Res Off Publ Orthop Res Soc. 2018.
Gerber C, Catanzaro S, Betz M, Ernstbrunner L. Arthroscopic correction of the critical shoulder angle through lateral acromioplasty: a safe adjunct to rotator cuff repair. Arthroscopy. 2018;34(3):771–80.
Karns MR, Jacxsens M, Uffmann WJ, Todd DC, Henninger HB, Burks RT. The critical acromial point: the anatomic location of the lateral acromion in the critical shoulder angle. J Shoulder Elb Surg. 2018;27(1):151–9.
Kirsch JM, Nathani A, Robbins CB, Gagnier JJ, Bedi A, Miller BS. Is there an association between the “critical shoulder angle” and clinical outcome after rotator cuff repair? Orthop J Sports Med [Internet]. 2017 Apr 18 [cited 2018 Jun 18];5(4). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400133/.
Cunningham G, Nicodème-Paulin E, Smith MM, Holzer N, Cass B, Young AA. The greater tuberosity angle: a new predictor for rotator cuff tear. J Shoulder Elb Surg. 2018;27(8):1415–21.
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Loriaud, A., Bise, S., Meyer, P. et al. Critical shoulder angle: what do radiologists need to know?. Skeletal Radiol 49, 515–520 (2020). https://doi.org/10.1007/s00256-019-03337-3
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DOI: https://doi.org/10.1007/s00256-019-03337-3