The supraspinatus distension sign: an indicator of supraspinatus integrity

Arthroscopy. 2009 Jun;25(6):617-9. doi: 10.1016/j.arthro.2008.11.009. Epub 2009 Jan 24.


Purpose: To determine if direct contact between the biceps tendon and supraspinatus in patients undergoing shoulder arthroscopy performed in the lateral decubitus position has predictive value in evaluating full-thickness and articular-sided, partial-thickness rotator cuff tears.

Methods: Five hundred sixty-three consecutive shoulder arthroscopies in the lateral decubitus position were performed by a single surgeon between September 2005 and September 2007. The presence or absence of distance between the biceps tendon and supraspinatus was evaluated upon entering the joint. A diagnostic arthroscopy of the glenohumeral and subacromial spaces then ensued to determine the presence and extent of rotator cuff tear.

Results: The biceps-supraspinatus interval was preserved in 211 of 232 (90.9%) of the articular-sided, partial-thickness tears. The biceps-supraspinatus space was absent in 76 of 77 (98.7%) of the full-thickness tears. After excluding cases of concomitant adhesive capsulitis, all 211 articular-sided, partial-thickness rotator cuff tears and only 1 of 75 (1.3%) full-thickness rotator cuff tears was associated with a preserved biceps-supraspinatus interval (false negative).

Conclusions: Our study further validates the high sensitivity and specificity of using the loss of supraspinatus distension for predicting full-thickness rotator cuff tears. We also report the reliable preservation of supraspinatus distension with articular-sided, partial-thickness rotator cuff tears. These articular-sided partial-thickness tears typically do not lead to sufficient egress of arthroscopic fluid from the glenohumeral joint to cause a loss of supraspinatus distension.

Level of evidence: Level IV, prognostic case series.

Publication types

  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arthroscopy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Muscle, Skeletal / pathology*
  • Rotator Cuff / pathology*
  • Rotator Cuff / surgery
  • Rotator Cuff Injuries
  • Sensitivity and Specificity
  • Young Adult