The critical shoulder angle is associated with osteoarthritis in the shoulder but not rotator cuff tears: a retrospective case-control study

J Shoulder Elbow Surg. 2017 Dec;26(12):2097-2102. doi: 10.1016/j.jse.2017.06.001. Epub 2017 Jul 21.


Background: In 2013 Moor et al introduced the concept of the critical shoulder angle (CSA) and suggested that an abnormal CSA was a leading factor in development of rotator cuff tear (RCT) and osteoarthritis (OA) of the shoulder. This study assessed whether the CSA was associated with RCT and OA and tested the inter- and intrarater reliability of the CSA when measuring RCT and OA.

Materials and methods: The study was performed as a retrospective case-control study. The cases comprised 2 groups: 97 patients with RCT and 87 patients with OA. The controls were matched 3:1, by age and sex, from a population of 795 patients with humeral fractures. The CSA was measured as described by Moor et al. Analysis of the relation with CSA for RCT and OA was done by logistic regression. Models were fitted separately for RCT and OA and used the controls matched to the respective cases. Inter- and intrarater reliability was determined by measuring the intraclass correlation coefficient and minimal detectable change.

Results: The mean CSA was 33.9° in the RCT group and 33.6° in the matched control group. The odds ratio for developing RCT for people with a CSA above 35° was 1.12 (P = .63). The mean CSA in the OA group was 31.1° and in the matched control group 33.3°. The odds ratio for developing OA for people with a CSA below 30° was 2.25 (P = .002). The CSA measurements showed strong intra- and inter-rater reliability, with intraclass correlation coefficient values above 0.92 and minimal detectable change values below 0.4°.

Conclusions: This study did not find any association between CSA and RCT but did show association between CSA and OA, with a 2.25 odds ratio of developing OA given the patient had a CSA below 30°. The results do not support the suggested praxis of shaving away the lateral border of the acromion to make the CSA smaller because it might increase the risk of developing OA without decreasing the risk of developing RCT. The CSA measurements showed excellent intra- and inter-rater reliability.

Keywords: Critical shoulder angle; humeral fractures; rotator cuff tear; shoulder; shoulder osteoarthritis; shoulder radiograph.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Observer Variation
  • Osteoarthritis / diagnostic imaging*
  • Osteoarthritis / epidemiology*
  • Radiography
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Factors
  • Rotator Cuff Injuries / diagnostic imaging*
  • Rotator Cuff Injuries / epidemiology*
  • Shoulder Joint / diagnostic imaging*
  • Young Adult