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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (4): 740-747. doi: 10.19723/j.issn.1671-167X.2025.04.018

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Association of increased greater tubercle angle and critical shoulder angle with rotator cuff tears

Hua JIANG1, Yu YAN2, Panpan LI1, Kang CHEN1, Hongbing MA1, Yong ZENG1, Xin TANG2, Guoqing CUI3,*()   

  1. 1. Department of Orthopedics, Chengdu Second People ' s Hospital, Affiliated Hospital of Chengdu Medical College, Chengdu 610017, China
    2. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China
    3. Department of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
  • Received:2024-09-29 Online:2025-08-18 Published:2025-08-02
  • Contact: Guoqing CUI
  • Supported by:
    the Project of Chengdu Health and Health Commission(2020090); the Special Fund of Sichuan Provincial Administration of Traditional Chinese Medicine(2024MS179)

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Abstract:

Objective: The greater tuberosity angle (GTA) and critical shoulder angle (CSA) are commonly referred to as radiographic markers which were used to described morphology of the greater tuberosity and acromion respectively. At present, most international studies focus on the correlation between the above two parameters and rotator cuff tears (RCTs), and their diagnostic value and risk assessment. This study attempts to find out the trend of GTA and CSA changes and risk threshold of RCTs, as well as the protective factors and risk factors. Methods: In this study, 130 individuals from May 2019 to December 2020 were recruited. According to Southern California Orthopedic Institute (SCOI) classification, the individuals were divided into four groups retrospectively: Group A, negative control group; Group B, partial tears (articular side); Group C, partial tears (bursal side); Group D, full-thickness tears. GTA and CSA were measured respectively on true anteroposterior position X-ray of shoulder with arm in neutral rotation and performed by the same trained technician team in single-blind. The correlations between RCTs and relevant factors were analyzed. Results: According to the area under the receiver operating characteristic curve (AUC), GTA and CSA of RCTs (Groups B, C and D) were 0.736 and 0.673 with 95% confidence interval (CI), the cut-off value of GTA and CSA of RCTs were 70.5° and 39.5° respectively. Comparing with the control group, RCTs groups had significant statistical differences in age and body mass index (BMI) (P < 0.05), especially the full-thickness RCTs (Group D), which was older than Groups A, B and C (P < 0.05, cut-off value: 56.5 years old) and shorter than Groups A and B (P < 0.05, cut-off value: 1.58 m). Analyzed from scatter plot and regression analysis, there was no linear correlation between GTA and CSA. There were no significant differences in gender, dominant shoulders and smoking between the RCTs groups and the control group (P>0.05). Conclusion: Larger GTA (>70.5°) and CSA (>39.5°) would be highly predictive in diagnosing RCTs without linear correlation, and GTA has a higher diagnostic value in contrast. Subacromial impingement and shoulder degeneration occurred before RCTs. Patients with age >56.5 years and height < 1.58 m were more likely to develop disease of full-thickness RCTs and no statistic differences in weight and BMI. Gender, dominant shoulder and smoking were neither risk factors nor protective factors.

Key words: Rotator cuff tears, Greater tuberosity angle, Critical shoulder angle, Shoulder impingement syndrome

CLC Number: 

  • R684

Figure 1

MRI images of patients with rotator cuff tears in each group A, negative control group; B, partial RCTs (articular side) group; C, partial RCTs (bursal side) group; D, full-thickness RCTs group. The arrow indicates the site of RCTs, the circle marks the osteophytes of greater tuberosity of humerus. RCTs, rotator cuff tears."

Figure 2

Measurement methods of GTA and CSA on apraxis of scapula Greater tuberosity angle (GTA) is made by two crossing lines. The first line passes through the center of humeral head and parallels to the humerus diaphysis, and the second one connects the upper border of the humeral head to the most superolateral edge of the greater tuberosity. Critical shoulder angle (CSA) consists of the angle with two crossing lines. One of which was drawn from the glenoid superior to inferior border, the other was drawn from the glenoid inferior border to lateral aspect of the acromion."

Table 1

Reliability of radiological measurements"

Measurements ICC-1 ICC-2 ICC-3
CSA 0.988 0.988 0.897
GTA 0.977 0.990 0.921

Figure 3

Enrollment flow chart Patients were screened and grouped according to inclusion and exclusion criteria (according to the exclusion criteria, 10 patients with RCTs were not included in this study and statistical analysis due to factors such as preoperative imaging data missing (not recorded) and non-timely review. RCTs, rotator cuff tears."

Table 2

Demographic data in each group"

Items Group A Group B Group C Group D P value
Age/years, ${\bar x}$±s 27.76±7.30 54.00±14.89 51.27±8.41 64.24±10.01 ＜0.001
Weight/kg, ${\bar x}$±s 58.90±6.51 63.83±9.06 63.27±6.13 61.43±10.06 0.075
Height/m, ${\bar x}$±s 1.64±0.50 1.65±0.78 1.62±0.68 1.59±0.07 0.001
BMI/(kg/m2), ${\bar x}$±s 21.82±1.73 23.24±1.91 24.04±1.54 24.10±2.93 ＜0.001
Gender (male/female), n 16/26 8/16 10/12 7/35 0.067
Shoulder (left/right), n 16/26 8/16 12/10 18/24 0.487
Smoking (yes/no), n 6/36 2/22 2/20 2/40 0.511

Table 3

Measured values of CSA and GTA in each group"

Items Group A Group B Group C Group D
CSA, ${\bar x}$±s 35.33±4.69 38.56±4.83 40.23±5.72 39.18±7.18
GTA, ${\bar x}$±s 68.36±3.06 70.54±3.08 71.09±5.31 72.62±5.37

Table 4

Multiple comparisons of CSA between groups (P value)"

Items Group A Group B Group C Group D
Group A - 0.028* 0.001** 0.002**
Group B 0.028* - 0.323 0.673
Group C 0.001** 0.323 - 0.485
Group D 0.002** 0.673 0.485 -

Figure 4

Analysis of critical values for CSA and GTA in RCTs patients under ROC curve ROC, receiver operating characteristic; GTA, greater tuberosity angle; CSA, critical shoulder angle; RCTs, rotator cuff tears."

Table 5

Multiple comparisons of GTA between groups (P value)"

Items Group A Group B Group C Group D
Group A - 0.045* 0.015* ＜0.001**
Group B 0.045 - 0.660 0.057
Group C 0.015* 0.660 - 0.172
Group D ＜0.001** 0.057 0.172 -

Figure 5

Scatter diagram of GTA and CSA GTA, greater tuberosity angle; CSA, critical shoulder angle."

Figure 6

Regression standardized residual (dependent variable: GTA) follows a standard normal distribution (95%CI: -2, 2) GTA, greater tuberosity angle."

Table 6

Odd ratios of RCTs groups"

Items Group B Group C Group D
OR (95%CI) P value OR (95%CI) P value OR (95%CI) P value
Gender (male/female) 1.231 (0.430-3.527) 0.699 0.738 (0.260-2.100) 0.569 3.077 (1.106-8.558) 0.050
Shoulder (left/right) 1.231 (0.430-3.527) 0.699 0.513 (0.180-1.458) 0.208 0.821 (0.343-1.963) 0.657
Smoke (yes/no) 1.833 (0.340-9.895) 0.476 1.667 (0.307-9.042) 0.551 3.333 (0.632-17.574) 0.137
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