Association between magnetic resonance imaging features and the degree of subacromial bursitis during arthroscopic surgery in isolated subacromial impingement syndrome
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Abstract
A retrospective cross-sectional study was conducted at Viet Duc University Hospital (07/2024–09/2025) on 78 patients with isolated subacromial impingement syndrome to determine the association between magnetic resonance imaging (MRI) parameters and the severity of subacromial bursitis observed during arthroscopy. The MRI parameters included acromiohumeral distance (AHD), critical shoulder angle (CSA), lateral acromial angle (LAA), subacromial volume (SAV), and osteophyte length. Comparisons were performed between the mild bursitis group and the moderate–severe bursitis group, followed by multivariate regression analysis and receiver operating characteristic (ROC) analysis to identify predictive factors. The results showed that 64.1% of patients had moderate–severe bursitis, with significantly lower AHD compared with the mild group (6.64 ± 0.67 mm vs 7.10 ± 0.67 mm; p = 0.006). Multivariate regression analysis identified AHD as the only independent factor (OR = 0.370; p = 0.032), with each 1-mm decrease increasing the risk of moderate–severe inflammation by 2.7 times. An AHD cutoff value ≤ 6.85 mm yielded 79% sensitivity and 68% specificity (AUC = 0.699; p = 0.004). Although SAV demonstrated predictive value, it was not an independent predictor, suggesting that AHD should be prioritized in preoperative evaluation.
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Keywords
Isolated subacromial impingement syndrome, shoulder MRI, subacromial bursitis, arthroscopy
References
2. Luime J, Koes B, Hendriksen I, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73-81. doi:10.1080/03009740310004667
3. Seitz AL, McClure PW, Finucane S, et al. Mechanisms of rotator cuff tendinopathy: Intrinsic, extrinsic, or both? Clin Biomech. 2011;26(1):1-12. doi:10.1016/j.clinbiomech.2010.08.001
4. Diercks R, Bron C, Dorrestijn O, et al. Guideline for diagnosis and treatment of subacromial pain syndrome. Acta Orthop. Published online June 1, 2014:314-322. doi:10.3109/17453674.2014.920991
5. Kaur R, Dahuja A, Garg S, et al. Correlation of acromial morphology in association with rotator cuff tear: a retrospective study. Pol J Radiol. 2019;84:e459-e463. doi:10.5114/pjr.2019.90277
6. Mayerhoefer ME, Breitenseher MJ, Roposch A, et al. Comparison of MRI and Conventional Radiography for Assessment of Acromial Shape. Am J Roentgenol. 2005;184(2):671-675. doi:10.2214/ajr.184.2.01840671
7. Banas MP, Miller RJ, Totterman S. Relationship between the lateral acromion angle and rotator cuff disease. J Shoulder Elbow Surg. 1995;4(6):454-461. doi:10.1016/s1058-2746(05)80038-2
8. Kocadal O, Tasdelen N, Yuksel K, et al. Volumetric evaluation of the subacromial space in shoulder impingement syndrome. Orthop Traumatol Surg Res. 2022;108(2):103110. doi:10.1016/j.otsr.2021.103110
9. Chaimongkhol T, Benjachaya S, Mahakkanukrauh P. Acromial morphology and morphometry associated with subacromial impingement syndrome. Anat Cell Biol. 2020;53(4):435-443. doi:10.5115/acb.20.166
10. Bhatnagar A. Correlation between MRI and Arthroscopy in Diagnosis of Shoulder Pathology. J Clin Diagn Res. Published online 2016. doi:10.7860/JCDR/2016/14867.7309
11. Hohmann E, Shea K, Scheiderer B, et al. Indications for Arthroscopic Subacromial Decompression. A Level V Evidence Clinical Guideline. Arthrosc J Arthrosc Relat Surg. 2020;36(3):913-922. doi:10.1016/j.arthro.2019.06.012
12. Kvalvaag E, Anvar M, Karlberg AC, et al. Shoulder MRI features with clinical correlations in subacromial pain syndrome: a cross-sectional and prognostic study. BMC Musculoskelet Disord. 2017;18(1):469. doi:10.1186/s12891-017-1827-3
13. Jo CH, Shin JS, Kim JE, Oh S. Macroscopic and microscopic assessments of the glenohumeral and subacromial synovitis in rotator cuff disease. BMC Musculoskelet Disord. 2015;16(1):272. doi:10.1186/s12891-015-0740-x
14. Monu JUV, Pruett S, Vanarthos WJ, Pope TL. Isolated subacromial bursal fluid on MRI of the shoulder in symptomatic patients: correlation with arthroscopic findings. Skeletal Radiol. 1994;23(7):529-533. doi:10.1007/BF00223084
15. Gimm G, Yoon JY, Ahn E, et al. Clinical Implication of Glenohumeral and Subacromial Synovitis in Rotator Cuff Tears. Orthop J Sports Med. 2023;11(11):23259671231207818. doi:10.1177/23259671231207818
16. Vaz A, Reifegerste CP, Trippia CR, et al. Effect of the acromial inferolateral tilt on subacromial impingement syndrome: a retrospective magnetic resonance imaging assessment. Radiol Bras. 2020;53:366-374. doi:https://doi.org/10.1590/0100-3984.2019.0127
17. Saupe N, Pfirrmann CWA, Schmid MR, et al. Association Between Rotator Cuff Abnormalities and Reduced Acromiohumeral Distance. Am J Roentgenol. 2006;187(2):376-382. doi:10.2214/AJR.05.0435
18. Gulcu A, Aslan A, Dincer R, et al. Relationship Between Diagnostic Anatomic Shoulder Parameters and Degenerative Rotator Cuff Tears: An MRI Study. Orthop J Sports Med. 2022;10(11):23259671221130692. doi:10.1177/23259671221130692
19. Hoàng Xuân Bình, Nguyễn Minh Hải. Đặc điểm tổn thương chóp xoay trên hình ảnh cộng hưởng từ 3.0 Tesla ở bệnh nhân có hội chứng chèn ép dưới mỏm cùng vai. Tạp chí Y học Việt Nam. 2024;541(3):3. doi:10.51298/vmj.v541i3.10835
20. Sasiponganan C, Dessouky R, Ashikyan O, et al. Subacromial impingement anatomy and its association with rotator cuff pathology in women: radiograph and MRI correlation, a retrospective evaluation. Skeletal Radiol. 2019;48(5):781-790. doi:10.1007/s00256-018-3096-0
21. Vosshenrich J, Bruno M, Cantarelli Rodrigues T, et al. Arthroscopy-validated Diagnostic Performance of 7-Minute Five-Sequence Deep Learning Super-Resolution 3-T Shoulder MRI. Radiology. 2025;314(2):e241351. doi:10.1148/radiol.241351
22. Lee D, Lee KH, Jo YH, et al. Correlation between Severity of Synovitis and Clinical Features in Rotator Cuff Tears. Clin Orthop Surg. 2021;13(1):88-96. doi:10.4055/cios20002