From the Guidelines
A high-riding humeral head on an X-ray in the setting of a rotator cuff injury indicates superior migration of the humeral head within the glenohumeral joint, suggesting a significant rotator cuff tear. This finding is crucial in assessing the severity of the injury, as it implies a chronic and possibly irreparable tear, particularly involving the supraspinatus tendon. The superior migration of the humeral head is a result of the deltoid muscle pulling the humeral head upward due to the lack of stabilization from the damaged rotator cuff. According to the study by 1, older patients are more likely to have rotator cuff tears in association with shoulder dislocation, which may be related to the high-riding humeral head finding.
Key Points to Consider
- The high-riding humeral head reduces the normal subacromial space, leading to impingement of the rotator cuff tendons against the acromion.
- This finding is often associated with a decreased acromiohumeral interval, typically measuring less than 7mm.
- Patients with this finding typically experience significant weakness, pain with overhead activities, and potentially limited range of motion.
- Treatment options depend on the severity of symptoms, patient age, and activity level, ranging from conservative management to surgical intervention, as noted in the context of shoulder dislocation or instability 1.
Clinical Implications
The presence of a high-riding humeral head on an X-ray report in the context of a rotator cuff injury has significant clinical implications, including the potential need for more extensive treatment and a possible poorer prognosis for recovery. It is essential to consider this finding in the overall assessment and management of the patient's condition.
From the Research
Definition of High Riding Humeral Head
- High riding humeral head refers to the superior migration of the humeral head in relation to the acromion, which can be an indication of rotator cuff disease or tear 2, 3, 4, 5, 6.
Causes of High Riding Humeral Head
- Rotator cuff tears, particularly full-thickness tears of the supraspinatus, infraspinatus, or subscapularis tendon, can lead to superior humeral head migration 2.
- The severity of rotator cuff tears and the number of torn tendons can also contribute to the degree of humeral head migration 2, 4.
- Individual variation in anatomical position of the humeral head in relation to the acromion can also play a role in the occurrence of rotator cuff pathology 5.
Radiographic Findings
- Decreased acromiohumeral distance (AHD) or acromiohumeral interval (AHI) can be an indication of rotator cuff tendinopathy or tear 2, 6.
- Upward migration index (UMI) can be used to evaluate the association between rotator cuff tear and the proximal migration of humeral head 4.
- Radiographic findings can be normal in the acute setting, but in more chronic cases, an outlet view may show decreased opacity and decreased size of the supraspinatus muscle due to atrophy 6.