Association between Hypertrophic Change of Greater Tuberosity in Plain Radiography and Rotator Cuff Tears

The purpose of this study is to evaluate the implications of greater tuberosity (GT) spurs by comparing findings from magnetic resonance imaging (MRI) and simple radiography. We hypothesize that observing hypertrophic changes in the GT will be more effective in predicting rotator cuff tears (RCTs) than relying on physical examinations alone and that plain radiography can serve as a reliable indicator for detecting RCTs and help with proceeding to special imaging studies.

This retrospective cohort study included 185 cases from January 2021 to August 2023, with 94 cases selected for the group showing GT spurs and 91 cases selected for the control group without GT spurs. Specifically, MRI was taken in those who had positive physical examination findings (Jobe's test and decreased external rotation power) of rotator cuff pathology without GT spur (control group) or had GT spur on a plain radiograph regardless of the physical examination findings (GT spur group).

Physical examination findings suggesting RCTs (positive Jobe's test and decreased external rotation power) were more frequently observed in the control group (82 / 94 [87.2%] in GT spur group vs. 91 / 91 [100%] in control group, p = 0.001). However, when comparing MRI results, the group with GT spurs showed more severe RCTs, defined as high-grade partial to full-thickness tears (84 / 94 [89.3%] vs. 61 / 91 [67.0%], p < 0.001), and particularly, the ratio of full-thickness tears was higher. When only patients with partial tears were considered (23 / 94 [24.5%] vs. 31 / 91 [34.1%]), the GT spur group showed a higher proportion of bursal side tears (18 / 23 [78.3%] vs. 17 / 31 [54.8%], p = 0.012).

GT spurs observed in plain radiographs of patients with shoulder pain were found to be predictive of supraspinatus tendon tears. Even if there are negative findings in the physical examination, patients with GT spurs should be considered for special imaging to evaluate the possibility of an RCT.