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The influence of radiographic viewing perspective and demographics on the critical shoulder angle.pdf

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The influence of radiographic viewing perspective and demographics on the critical shoulder angle.pdf

Funding: This in Design and Bio Center for Rese Translational S 5UL1TR001067 This study is ex versity of Utah vices Using Dec J Shoulder Elbow Surg (2015) 24, e149-e158 1058-2746/$ - s /locate/ymseThe influence of radiographic viewing perspective and demographics on the critical shoulder angleThomas Suter, MDa,b, Ariane Gerber Popp, MDb, Yue Zhang, PhDc, Chong Zhang, MSc, Robert Z. Tashjian, MDa, Heath B. Henninger, PhDa,d,*aDepartment of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA bDepartment of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland cDivision of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA dDepartment of Bioengineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USABackground: Accurate assessment of the critical shoulder angle (CSA) is important in clinical evaluation of degenerative rotator cuff tears. This study analyzed the influence of radiographic viewing perspective on the CSA, developed a classification system to identify malpositioned radiographs, and assessed the rela- tionship between the CSA and demographic factors. Methods: Glenoid height, width, and retroversion were measured on 3-dimensional computed tomography reconstructions of 68 cadaver scapulae. A digitally reconstructed radiograph was aligned perpendicular to the scapular plane, and retroversion was corrected to obtain a true anteroposterior (AP) view. In 10 scap- ulae, incremental anteversion/retroversion and flexion/extension views were generated. The CSA was measured, and a clinically applicable classification system was developed to detect views with 2 change in CSA vs. true AP view. Results: The average CSA was 33 4. Intraobserver and interobserver reliability was high (intraclass correlation coefficient 0.81) but decreased with increasing viewing angle. Views beyond 5 anteversion, 8 retroversion, 15 flexion, and 26 ext