Ultrasound and operative evaluation of arthritic shoulder joints

Abstract

Objective-To assess the diagnostic value of ultrasonography (US) in the evaluation of arthritic shoulder joints. Methods-Twenty shoulders of 20 inpatients with arthritis were evaluated by US one day before the shoulder operation. Changes in the subacromial-subdeltoid bursa, biceps tendon and tendon sheath, rotatof cuV, and glenohumeral joint were recorded and compared with findings at operation. Results-In the detection of eVusion/ hypertrophy in the subacromial-subdeltoid bursa, US had a sensitivity of 93% and a specificity of 83%. For a biceps tendon rupture US had a sensitivity of 70% and a specificity of 100%. US missed three intraarticular biceps tendon ruptures. For eVusion/hypertrophy in the biceps tendon sheath US had a sensitivity of 100% and a specificity of 83%. For a rotator cuV tear US had a sensitivity of 83% and a specificity of 57%. US missed two small longitudinal rotator cuV tears. Three thin membranous, but intact, rotator cuV tendons were classified as full thickness tears by US. Synovial eVusion/hypertrophy was detected by US and at operation in all of the 12 glenohumeral joints that were evaluable at surgery. Conclusion-US is a reliable method in experienced hands for the evaluation of inflammatory changes of an arthritic shoulder. In advanced stages of rheumatoid shoulder joints, however, US is not useful, because destructive bone changes and tendon ruptures change the normal anatomy and restrict shoulder motions, limiting the visibility of US.

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

“…1 Although good results have been reported with the use of these modalities to diagnose rotator cuff tears, each has significant drawbacks. 8,17 These include invasiveness, discomfort, expense, inconvenience, and variability of results.…”

Häufigkeit einer Bizepssehnentenosynovitis bei Gehhilfenverwendung

“…So wiesen Alasaarela et al [1] auf eine Sensitivität von 100% bei einer Spezifität von 83% im Hinblick auf eine Entzündung/Hypertrophie der Bizepssehnenscheide hin -gesichert durch operative Verfahren.…”

Technik und Stellenwert der Arthrosonographie in der rheumatologischen Diagnostik -

“…Die Sonographie ist an der Schulter in der Lage verschiedene Befunde zu differenzieren, kann aber grundsätzlich nicht zwischen verschiedenen rheumatologischen Diagnosen unterscheiden. Die Sonographie ist demnach für die Diagnostik der früharthriti-schen Erkrankungen des rheumatischen Formenkreises in der Hand des geübten Untersuchers besonders geeignet, indem die Veränderungen im Sinne von Synovitis, Synovialitis, Tendinitis und Tendopathie an der Rotatorenmanschette sowie der langen Bizepssehne akurat zur Darstellung gebracht werden können (1,3,7,8,12,25).…”

“…Compared to computer tomography and magnetic resonance imaging, ultrasonography should be used as a screening method. The following standard scans are suggested for sonographic evaluation of the shoulder: 1) anterior transverse scan and 2) anterior longitudinal scan at the bicipal groove to detect synovitis and tenosynovitis, 3) anterior transverse scan at the coracoacromiale window in the neutral position, 4) at maximal external rotation and 5) at maximal internal rotation to evaluate the rotator cuff, bursitis, synovitis and erosions, 6) anterior longitudinal scan at 908 to the coracoacomiale window at maximal internal rotation to describe these findings in an additional dimension, 7) anterior-lateral longitudinal scan at the anterior lateral acromion to tuberculum majus to evaluate the distal part of the supraspinatus muscle, 8) posterior transverse scan at the fossa infraspinata lateral under the spina scapulae, 9) axillary longitudinal scan to evaluate synovitis, synovial proliferation, erosions at the humeral head, lesions at the glenoidale labrum, 10) anterior transverse scan at the acromioclavicular joint and 11) anterior oblique scan at the sternoclavicular joint to detect synovitis, synovial proliferation, erosion, osteophytes.…”