Clinical Applications of Ultrasonography in the Shoulder and Elbow

Lin, Albert; Gasbarro, Gregory; Sakr, Mark

doi:10.5435/jaaos-d-16-00257

Cited by 8 publications

(5 citation statements)

References 40 publications

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“…Recently, higher-frequency probes and smaller machines have been developed that have allowed for much better accuracy in diagnosis and in-office use by orthopedic surgeons 12, 27. Advancements in the equipment along with improvements in technique have allowed ultrasound to achieve accuracy equal to magnetic resonance imaging (MRI) in the diagnosis of both full-thickness and partial-thickness rotator cuff tears at a much lower cost 5, 19…”

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confidence: 99%

Do we really need to order magnetic resonance imaging? Shoulder surgeon ultrasound practice patterns and beliefs

Kruse¹,

Dilisio

Wang

et al. 2019

JSES Open Access

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Background Despite significant benefits, many orthopedic surgeons are hesitant to incorporate diagnostic ultrasound into their practice. This may be because of a lack of comfort, knowledge, and/or training. The purpose of this study was to analyze practice patterns regarding the use of shoulder ultrasound by orthopedic surgeons to diagnose rotator cuff tears. Materials and methods We conducted a survey of the members of the American Shoulder and Elbow Surgeons (ASES) regarding their use of ultrasound. A systematic review of the literature on the use of ultrasound in the shoulder by orthopedic surgeons was also performed. Results Of the members of ASES responding to the survey, 55% are using ultrasound for diagnostic purposes in the shoulder. The leading reason for not using ultrasound as the sole imaging modality prior to performing rotator cuff repair was lack of confidence in the ability to determine the reparability of the tear (83%). Our systematic review showed that for an orthopedic surgeon diagnosing a full-thickness rotator cuff tear, the mean sensitivity was 92% and mean specificity was 89%. Conclusions Many ASES surgeons are not using ultrasound in the shoulder despite its many potential benefits over magnetic resonance imaging. This is because of a lack of confidence in the ability to quantify fatty infiltration, muscle atrophy, and the level of retraction medial to the acromion. Our systematic review showed that orthopedic surgeons can be accurate in the diagnosis of full-thickness rotator cuff tears. Future research should focus on defining parameters of shoulder ultrasound associated with rotator cuff tendon reparability. Educating surgeons on ultrasound technique, cost, and evidence may be a promising strategy to enhance the value in musculoskeletal care delivery.

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mentioning

confidence: 99%

Do we really need to order magnetic resonance imaging? Shoulder surgeon ultrasound practice patterns and beliefs

Kruse¹,

Dilisio

Wang

et al. 2019

JSES Open Access

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“…Despite the hesitancy for orthopaedic surgeons to use ultrasound, studies have repeatedly shown that orthopaedic surgeons are capable of diagnosing musculoskeletal injuries with ultrasound after a teaching workshop. 12,13 Orthopaedists have the distinct advantage of surgical experience lending to a deeper understanding of the relevant anatomy that makes ultrasound a useful tool to evaluate for injuries noninvasively.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound assessment of distal biceps tendon injuries

Dove

Pasquarello

DaSilva

2022

Current Orthopaedic Practice

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Section: Discussionmentioning

confidence: 99%

“…The potential for surgeons to rapidly gain US proficiency in the diagnosis of rotator cuff tears has also led to an increased push to include US training in orthopaedic residency programs. 27 Five studies evaluated in this review included US and MRI diagnostic outcome data with arthroscopy as reference. 2,10,15,47,50 After meta-analysis, no significant differences were found in US and MRI diagnostic sensitivity, specificity, and accuracy for any sized-thickness, fullthickness, or partial-thickness supraspinatus tears (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Ultrasonography for Rotator Cuff Tears: A Systematic Review and Meta-analysis

Farooqi

Lee

Novikov

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: With recent improvements in transducer strength, image resolution, and operator training, ultrasound (US) provides an excellent alternative imaging modality for the diagnosis of rotator cuff tears. Purpose: To evaluate the diagnostic accuracy of US for partial- and full-thickness rotator cuff tears and biceps tendon tears, compare diagnostic values with those of magnetic resonance imaging (MRI) using arthroscopy as the reference standard, assess longitudinal improvements in accuracy, and compare diagnostic values from operators with different training backgrounds. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed and Cochrane Library databases were systematically searched for full-text journal articles published between January 1, 2010, and April 1, 2020. The inclusion criteria were studies that evaluated the diagnostic accuracy of US for rotator cuff tears or biceps tendon tears utilizing arthroscopy as the reference standard. The exclusion criteria were studies with <10 patients, studies including massive tears without reporting diagnostic data for specific tendons, and studies lacking diagnostic outcome data. Extracted outcomes included diagnostic accuracy, sensitivity, specificity, negative predictive value, and positive predictive value. The mean difference and 95% confidence interval were calculated for both US and MRI diagnostic values, and meta-analysis was conducted using the Mantel-Haenszel random-effects model. Results: In total, 23 eligible studies involving 2054 shoulders were included. US demonstrated a higher median diagnostic accuracy for supraspinatus tendon tears (0.83) and biceps tendon tears (0.93) as compared with subscapularis tendon tears (0.76). US was found to have a higher median accuracy (0.93) for full-thickness supraspinatus tears than partial-thickness tears (0.81). US had superior median sensitivity for partial-thickness supraspinatus tears when performed by radiologists as opposed to surgeons (0.86 vs 0.57). Meta-analysis of the 5 studies comparing US and MRI demonstrated no statistically significant difference in diagnostic sensitivity, specificity, or accuracy for any thickness supraspinatus tears (P = .31-.55), full-thickness tears (P = .63-.97), or partial-thickness tears ( P = .13-.81). Conclusion: For experienced operators, US is a highly sensitive and specific diagnostic modality for the diagnosis of supraspinatus tears and demonstrates statistically equivalent capability to MRI in the diagnosis of both full- and partial-thickness rotator cuff tears.

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Clinical Applications of Ultrasonography in the Shoulder and Elbow

Cited by 8 publications

References 40 publications

Do we really need to order magnetic resonance imaging? Shoulder surgeon ultrasound practice patterns and beliefs

Do we really need to order magnetic resonance imaging? Shoulder surgeon ultrasound practice patterns and beliefs

Ultrasound assessment of distal biceps tendon injuries

Diagnostic Accuracy of Ultrasonography for Rotator Cuff Tears: A Systematic Review and Meta-analysis

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