Evaluation of chronic tears of the rotator cuff by ultrasound

Abstract

T he diagnosis of chronic lesions of the rotator cuff is challenging. We have developed a new index to improve the sonographic diagnosis of chronic tears of the cuff.In a pilot study, we examined 50 asymptomatic healthy volunteers by ultrasound to establish the diameter of the rotator cuff in relation to the tendon of the long head of biceps. Subsequently, the index was calculated in 64 patients who had had shoulder pain for more than three months caused by clinically diagnosed lesions of the rotator cuff. The compensatory hypertrophy of the biceps tendon was quantified sonographically in relation to the diameter of the cuff.Comparison with the contralateral shoulder revealed a significantly higher biceps rotator-cuff ratio (p < 0.05) for patients with torn rotator cuffs. A ratio greater than 0.8 was considered pathological (index positive); the mean ratio in the control group was 0.43. The sensitivity of a positive index was 97.8%, the specificity 63.2%, the positive predictive value 86.3%, and the negative predictive value 92.4% in comparison with surgical findings.Use of the index improves sensitivity in the diagnosis of chronic tears of the cuff by ultrasound. [Br] 1999;81-B:675-8. J Bone Joint Surg Received 1 December 1997; Accepted after revision 6 February 1998The diagnosis of tears of the rotator cuff by ultrasound is still uncertain. Some descriptions, such as inhomogeneity, sonographically-detectable effusions into the tendon sheath of the long head of biceps of patients with tears of the rotator cuff and other soft-tissue abnormalities. A partial tear of the rotator cuff may present with no more than nocturnal pain or a minor functional loss. Even with modern diagnostic facilities such as MRI, difficulties of definition are seen after scar formation and the compensatory hypertrophy of muscles of the shoulder girdle.Arthrography has been used in the diagnosis of acute, complete ruptures of the rotator cuff, 4 but it is an invasive procedure with a high rate of delayed morbidity 4,5 and it is expensive. Conventional radiological findings include a narrowing of the acromiohumeral interval, decalcification of the greater tuberosity or a reversal of the normal convexity of the inferior surface of the acromion. These appearances are not specifically diagnostic of tears of the rotator cuff. 6Patients and MethodsIn a pilot study we examined 50 asymptomatic healthy volunteers (25 women and 25 men) by ultrasound to establish standard values for the diameter of the rotator cuff in relation to the long tendon of biceps. The mean age of the group was 32 years (19 to 52) and 46 (91.6%) were righthanded. A commercially available real-time 7.5MHz linear scanner (Siemens) was used. The sonographic protocol was standardised by scanning the infraspinatus, supraspinatus and biceps tendon in longitudinal and transverse planes. The supraspinatus tendon was identified using the biceps tendon as a landmark. No abnormalities of the biceps tendon were seen. It was measured sonographically in relation to the diameter of the rot...

Supraspinatus tendon and subacromial space parameters measured on ultrasonographic imaging in subacromial impingement syndrome

“…Supraspinatus tendon thickness was represented as the average of thickness measured at 3 locations along the tendon. This method used in previous studies [4, 13, 22] and reported to have excellent reliability, and we also had excellent reliability. Other measures of supraspinatus tendon thickness may yield different results.…”

“…Two ultrasound images were captured and saved for later measurements. Three positions along the tendon were measured for thickness in millimetres (mm) at 10, 15, and 20 mm lateral to the reference point of the lateral point of hyperechogenicity of the biceps tendon [4, 9, 22]. The tendon borders were defined inferiorly as the first hyperechoic region above the anechoic articular cartilage of the humeral head, and the hyperechoic superior border of the tendon before the anechoic subdeltoid bursa.…”

“…Diagnostic ultrasound has been used to study tendon parameters about the shoulder [3, 4, 9, 10, 13, 14, 17, 22]. The supraspinatus tendon has been found to be thicker in two studies [9, 13], but thinner in another study [4] in those with subacromial impingement syndrome as compared to asymptomatic shoulders.…”

Ultrasound measurement of rotator cuff thickness and acromio-humeral distance in the diagnosis of subacromial impingement syndrome of the shoulder

“…The mean value calculated on the basis of the three measurements allowed for estimation of overall (average) cuff thickness (within the supraspinatus and infraspinatus tendons) with one numerical value. The above described method of measurement was similar to the one described by Wallny et al [24]. 3.…”

Ultrasound measurement and grading of rotator cuff and shoulder joint disease in patients with inflammatory arthritis: a reliability study

“…The thickness of the rotator cuff tendons and shoulder joint changes were measured using previously published methods 10–12 (Table 1a). In the interest of keeping scanning times to a minimum the primary measurements were not obtained at the time of scanning but subsequently using the electronic caliper feature in Osirix imaging software running on a digital workstation (Apple, Cupertino, CA, USA).…”