Greater tuberosity changes as revealed by radiography: Lack of clinical usefulness in patients with rotator cuff disease

OBJECTIVE. Studies linking greater tuberosity findings on radiographs with rotator cuff disease have largely been uncontrolled and biased toward more severe disease. We correlated greater tuberosity changes seen on radiograph y with rotator cuff disease seen on MR images in a broadly symptomatic pati ent population. MATERIALS AND METHODS. Both radiography and MR imaging were performed in 10 8 shoulders. Unaware of the MR imaging findings, three radiologists indepen dently reviewed the radiographs for cortical thickening, subcortical sclero sis, and cystlike lesions in the humeral greater tuberosity. Interobserver agreement was analyzed using kappa statistics. We correlated the radiograph ic findings with MR imaging evidence of rotator cuff tears and tendonopathy . The positive predictive value of each finding for rotator cuff disease wa s also calculated. RESULTS. Interobserver agreement for the three radiographic findings was po or to fair: Kappa values ranged from .06 to .41. Cortical thickening and su bcortical sclerosis were not seen more frequently in shoulders with rotator cuff disease than in normal shoulders. Cystlike lesions were more prevalen t in shoulders with rotator cuff disease, but the association reached stati stical significance (p <.05) for one observer only. Positive predictive val ues for each finding were low (14-48% for predicting full-thickness rotator cuff tears). CONCLUSION. Cortical thickening of the greater tuberosity and subcortical s clerosis are not associated with rotator cuff disease. For some observers, identifying cystlike lesions is associated with rotator cuff disease, but t he clinical usefulness of the observation is limited by high interobserver variability and poor positive predictive value.