The Clinical Role of Shoulder Ultrasound

Abstract

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.

The use of in-office, orthopaedist-performed ultrasound of the shoulder to evaluate and manage rotator cuff disorders

“…1,3,4,9,14,23,25,32 Regardless of the findings, these series and others stress the operator dependence of the procedure, which leads to the variability in results. 11,12,18,28,29 It has been this variability that has deterred many physicians from using ultrasound more frequently. Although technique is highly operator-dependent, results can be markedly improved if a †References 1, 3, 4, 6, 8-11, 14, 15, 20, 22, 23, 25-27, 30-33. ‡References 6, 8, 10, 11, 15, 20, 22, 26, 27, 30, 31, 33. specific protocol is followed and certain errors of interpretation are avoided.…”

Diagnosis of Shoulder Pain by History and Selective Tissue Tension: Agreement Between Assessors

“…8 Ultrasonography is valuable for detecting full thickness tears, but less so for small tears. 8,19,21 Furthermore, asymptomatic tears are common, 16,18 so that lesions correctly diagnosed by imaging modalities are of uncertain significance.…”

Diagnostic ultrasound of the shoulder—a method for experts only?

“…This reluctance in applying the method has been justified by its requirement for examiner experience and its long learning curve. This view has been supported by the personal experiences of some authors (Sonnabend et al 1997, Middelton et al 1998, Swen et al 1999, Backhaus et al 2001), but has been documented only to a limited extent in literature. Our results, derived from a novice, indicate that the method is more accessible than expected.…”

“…On the other hand, there were 12 false negative results in our study of 79 shoulders. For fullthickness tears, missing 6 of 26 cases is not too far removed from what can be achieved by more experienced examiners (Farin et al 1996, Sonnabend et al. 1997, Teefey et al 2004, Ziegler 2004) and it confirms the method's competitiveness with other imaging techniques of the soft parts of the shoulder (Farin et al 1966, Swen et al 1999, Teefey et al 2004.…”