Appendix 2
Clinical Evaluation
1)Patient name + birthdate:
2)Examination date: ______
3)Examiner:ML MK PT DATE: ______
ACROMION
4)Acromial configuration (sagittal view)
Type 1 Type 2 Type 3 Deformed
5)Degenerative hypertrophy of acromioclavicularjoint
Yes No
6)Acromial nonunion
Yes No
7)Acromiohumeral distance (shortest distance from cortex to cortex)
Minimal distance (mm, coronal view) ______
GLENOHUMERUS
8)Anterior subluxation of caput humeri (>5 mm)
Yes No
9)Glenohumeral osteoarthritis
None
Mild (osteophyses on the edges of tub major, glenoideum, and
borderzone of caput/collum, some sclerosis, small cysts)
Severe (narrowing of joint space, marked thickening of the
edges, marked sclerosis and cyst formation in caput and
glenoid cavity)
Subchondral bone cysts (under articular surface)
10)Caput Yes No
11)Glenoidal Yes No
Humeral head
12)Bone marrow edema Yes No
13)Degenerative changes None Mild Severe
(sclerosis) (sclerosis+cysts)
Glenoidal labrum
14)Normal Yes No
15)Degeneration Yes No
16)Tear Yes No
17)Loose bodies Yes No
18)Noncommunicating fluid collection
Yes No
19) Location ______
20)Biceps tendon Normal Partial tear Total tear
21)Biceps in sulcus? Yes No
22)Other
ROTATOR CUFF
23)Rotator cuff tear Yes No
24)Size _____ x _____
SUBSCAPULARIS
25) Normal Partial tear Full thickness tear
26)Goutallier fatty degeneration (axial view)
Stage 0 (no fat in muscle belly)
Stage 1 (some fatty streaks)
Stage 2 (fat < muscle), ie, marked fatty infiltration, but less fat than muscle in studied surface area
Stage 3 (fat = muscle)
Stage 4 (fat > muscle)
Marked reduction of volume with total atrophy
SUPRASPINATUS
27) Normal Partial tear Full thickness tear
28)Goutallier fatty degeneration(axial view)
Stage 0 (no fat in muscle belly)
Stage 1 (some fatty streaks)
Stage 2 (fat < muscle), ie, marked fatty infiltration but less fat than muscle in studied surface area
Stage 3 (fat = muscle)
Stage 4 (fat > muscle)
Marked reduction of volume with total atrophy
INFRASPINATUS
29) Normal Partial tear Full thickness tear
30)Goutallier fatty degeneration (axial view)
Stage 0 (no fat in muscle belly)
Stage 1 (some fatty streaks)
Stage 2 (fat < muscle), ie, marked fatty infiltration but less fat than muscle in studied surface area
Stage 3 (fat = muscle)
Stage 4 (fat > muscle)
Marked reduction of volume with total atrophy
TERES MINOR
31) Normal Partial tear Full thickness tear
32)Goutallier fatty degeneration (axial view)
Stage 0 (no fat in muscle belly)
Stage 1 (some fatty streaks)
Stage 2 (fat < muscle), ie, marked fatty infiltration but less fat than muscle in studied surface area
Stage 3 (fat = muscle)
Stage 4 (fat > muscle)
Marked reduction of volume with total atrophy
Other