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J Shoulder Elbow Surg. 2017 Dec;26(12):e376-e381. doi: 10.1016/j.jse.2017.05.020. Epub 2017 Jul 20.

Critical shoulder angle is associated with full-thickness rotator cuff tears in patients with glenohumeral osteoarthritis.

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New England Baptist Hospital, Boston, MA, USA.
New England Baptist Hospital, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA.
Maine Medical Center, Portland, ME, USA.
New England Baptist Hospital, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA. Electronic address:



Higher critical shoulder angle (CSA) is correlated with rotator cuff tears (RCTs), whereas lower CSA is associated with glenohumeral osteoarthritis (OA). Our goal was to investigate whether patients with concurrent glenohumeral OA and full-thickness RCTs demonstrate a higher CSA than patients with OA alone.


Using a 2-surgeon shoulder arthroplasty registry, we identified 31 patients with glenohumeral OA and full-thickness RCTs confirmed by plain radiography and magnetic resonance imaging, respectively. Sixty-two age- and gender-matched controls (1:2 ratio) with glenohumeral OA and an intact rotator cuff were identified from the same registry. Two independent observers evaluated the radiographs for CSA and acromiohumeral index.


The average CSA was 30° in the OA control group and 35° in the concurrent RCT and OA group (P < .0001). Acromiohumeral index was comparable between the groups (P = .13). Interobserver reliability of the independent reviewers was excellent (κ = 0.89; Ρ = 0.95). The receiver operating characteristic curve for CSA demonstrated that a value >35° was 90% specific and 52% sensitive for a full-thickness RCT in the setting of OA (area under curve = 0.84).


Concurrent glenohumeral OA and full-thickness RCT are associated with greater CSA values compared with patients with glenohumeral OA alone. The CSA measurement may be useful in determining the need for magnetic resonance imaging to assess rotator cuff integrity in the arthritic population.


Critical shoulder angle; arthroplasty; glenohumeral osteoarthritis; magnetic resonance imaging (MRI); rotator cuff tear; shoulder radiograph

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