DIAGNOSTIC-VALUE OF PLAIN RADIOGRAPHS IN ROTATOR CUFF TEAR

To assess the value of the Leclercq maneuver (anteroposterior roentgen ogram of the shoulder during resisted active abduction) for the diagno sis of rotator cuff tear, the medical records of 93 patients evaluated by glenohumeral arthrography, standard radiographs, and radiographs t aken using the Leclercq maneuver were retrospectively reviewed. The co mparison of patients with (n = 53) and without (n = 40) arthrographic evidence of rotator cuff tear demonstrated statistically significant d ifferences for mean acromiohumeral space difference between the normal and affected shoulders, for the acromiohumeral space difference betwe en the standard film and Leclercq maneuver film, and for presence of a n inferior glenohumeral diastasis on the Leclercq maneuver film. An ac romiohumeral space of 7 mm or less on standard radiographs proved a sp ecific (0.975) but insensitive (0.24) sign of rotator cuff tear. This parameter measured on the Lelercq maneuver film exhibited better sensi tivity (0.62) and excellent specificity. Other criteria with good spec ificity for rotator cuff tear included an acromiohumeral space differe nce between the normal and abnormal side of 2 mm or more (0.97), an ac romiohumeral space difference between standard and Leclercq maneuver f ilms of at least 4 mm, and existence of an inferior glenohumeral diast asis ; however, sensitivities of these three parameters were poor (res pectively 0.65 ; 0.20 ; and 0.19). A criterion with good sensitivity ( 0.77) and excellent specificity (0.975) was presence on the Leclercq m aneuver film of at least one of the four following findings : acromioh umeral space of 7 mm or less , acromiohumeral space difference between normal and abnormal sides of 2 mm or more, acromiohumeral space diffe rence between the standard and Leclercq films of 4 mm or more, or exis tence of an inferior glenohumeral diastasis. These data show that plai n roentgenograms of the shoulder, including an anteroposterior view du ring resisted active abduction, are usually adequate for the diagnosis of rotator cuff tear, making diagnostic arthrography unnecessary.