The value of sonoelastography in the diagnosis of supraspinatus tendinopathy—a comparison study

Abstract

Rotator cuff tendinopathies are a prevalent cause of reduced activity or disability in the general population. Patients may present with decreased shoulder function such as painful shoulder movements, a painful arc, weakness, discomfort, and stiffness. On clinical evaluation, weak external rotators, a weak supraspinatus, and signs of impingement may be found. 1 Sonoelastography (SE) by measuring stiffness helps to assess the biomechanical and structural properties of tissues. 2 Ultrasound (USG) is an easily accessible imaging tool that relies on alteration of echogenicity for diagnosis of tendinopathy. However, the abnormal tendon may have similar echogenicity to that of the surrounding healthy tissues, making diagnosis difficult in tendinopathy. MRI takes into account change in signal pattern while CT looks at changes in attenuation. These modalities lack the capability of showing very early changes in tendinopathy, which involve alteration of stiffness of the tendon. In the present study, however, we could not come across a case where SE was abnormal and MRI was normal in a symptomatic patient. We undertook this study in order to further understand the utility of SE in the detection of supraspinatus tendinopathies and comparing SE findings with that of MRI. MeThoDs anD MaTerials Subjects Ours was a prospective cross-sectional study, performed over a period of 15 months on 25 consecutive patients (Table 1) (7 females, 18 males; mean age 41.7 years; age range 25-75 years) who had history of mild to moderate discomfort during activity with no significant motion limitation and tenderness over the area of the greater tuberosity, suggested rotator cuff tendinopathy. In all patients, blunt trauma/ open wounds, full thickness supraspinatus tendon (SST) tear, or a previous surgery, and other general contraindications for MRI were excluded. An informed written consent from the patient was taken. The patients were first evaluated with real-time SE followed by MRI. The Ethical Committee and Review Board of our Institution (Department of Radio-diagnosis, Bharati Hospital and Research Centre, Pune, India) approved the study.

Elastographic Analysis of the Supraspinatus Tendon in Different Age Groups

“…Studies about supraspinatus tendon, such as ours, also revealed that degenerative tendinopathy is associated with greater capacity of tendon deformation during elastographic evaluation. ( 16 )- ( 19 On the other hand, Baumer et al ( 20 evaluated the influence of age on supraspinatus tendon shear modulus in individuals of different ages and observed that older individuals had stiffer tendons. However, unlike our study, the measurement was carried out in the intra-muscular portion of the tendon, which does not allow the isolated evaluation of the tendon itself, but also involves the muscle belly itself.…”

Sonoelastography of the Shoulder: A Narrative Review

“…Vasishta et al assessed the relationship between tendon stiffness on SE and supraspinatus tendinopathy grading on MRI (Grade I, normal; Grade II, mild tendinopathy; Grade III, moderate tendinopathy; and Grade IV, marked tendinopathy) in 25 patients ( 10 ). They reported a good correlation between the supraspinatus tendon strain ratios and the MRI grade: the strain ratio decreased with increasing severity of tendinopathy.…”

A novel measurement to evaluate supraspinatus tendinopathies with strain elastography

“…Vasishta et al (16) reported that strain elastography shows a moderate to strong association with MRI findings of tendinopathy. That study has the closest subject to ours.…”