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Background: Rotator cuff surgery is facilitated by accurate pre-operative information regarding the presence and size of cuff tears, and the extent of any cuff retraction or lamination. Methods: A total of 1 17 consecutive patients who underwent shoulder ultrasound followed by surgical management were assessed, and the pre-operative ultrasound diagnoses were correlated with the operative findings. Results: Ultrasound was found to be reliable for the detection of full-thickness cuff tears (positive predictive value 96%). In the assessment of partial thickness tears, ultrasound produced few false positives, but failed to diagnose a significant proportion of these lesions. Lamination and other interstitial cuff pathology were not reliably detected by ultrasound. In the diagnosis of subacromial impingement, ultrasound produced few false positives (positive predictive value 95%), but did produce a significant number of false negative results (negative predictive value 66%). Conclusions: Ultrasound is cheaper than MRI and arthrography, and is both non-invasive and 'dynamic'. It is reliable in the diagnosis of full-thickness cuff tears and is a useful adjunct in the diagnosis of cuff impingement and partial thickness tears, but is very much operator-dependent.

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