US appearance of partial-thickness supraspinatus tendon tears: Application of the string theory. Pictorial essay

Guérini, H.; Fermand, M; Godefroy, D.; Feydy, A.; Chevrot, A.; Morvan, G.; Gault, N.; Drapé, Jean‐Luc

doi:10.1016/j.jus.2011.12.001

Cited by 12 publications

(6 citation statements)

References 21 publications

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“…The disproportionate fluid sign is visible as a result of this. Consistent with our results, it has anecdotally been suggested that the identification of a disorder affecting the subacromial-subdeltoid bursa without intra-articular fluid collection should cause the physician to look carefully for a lesion affecting the bursal surface of the tendon (22). Therefore, given the MR findings of a near fullthickness tendon defect at the footprint and prominent subacromial-subdeltoid bursal fluid despite a lack of effusion in the glenohumeral joint, the so-called positive ''disproportionate fluid sign,'' we believe that a deep bursal-sided partial-thickness tear can easily be differentiated from a full-thickness tear.…”

Section: Discussionsupporting

confidence: 89%

Disproportionate fluid sign as an aid in diagnosing high-grade bursal-sided supraspinatus tendon tear

et al. 2017

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Background Deep, high-grade bursal-sided supraspinatus tendon tears are sometimes preoperatively misinterpreted as full-thickness tears on shoulder magnetic resonance imaging (MRI). Purpose To determine the usefulness of disproportionate fluid sign for differentiating high-grade bursal-sided partial-thickness tears from full-thickness tears on conventional MRI. Material and Methods Preoperative MRIs of 198 patients with arthroscopically confirmed high-grade bursal-sided partial-thickness tears and full-thickness tears were independently reviewed by two readers on two occasions. The presence of high-grade bursal-sided partial-thickness tears with a confidence level using a five-point grading scale was assessed based on tear depth alone and also in combination with disproportionate fluid sign, defined as a prominent subdeltoid or subacromial-subdeltoid bursal fluid distension with a relative paucity of effusion in the glenohumeral joint. The sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) were calculated, as well as inter-observer reliability. Results The disproportionate fluid sign was identified in 60/74 (81.2%) bursal-sided partial-thickness tears and 9/124 (7.5%) full-thickness tears. The sensitivity and accuracy of the diagnosis of bursal-sided tear were higher when disproportionate fluid sign was used in conjunction with the tear depth, compared with tear depth alone ( P < 0.001). There was excellent inter-observer agreement for disproportionate fluid sign and deep bursal-sided tear. The AUCs were significantly higher in combination with disproportionate fluid sign. Conclusion The disproportionate fluid sign indicates the presence of a deep, high-grade bursal-sided partial-thickness tear, which can be misinterpreted as a full-thickness tear. Thus, it can provide greater diagnostic assistance to less-experienced radiologists and clinicians.

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Section: Discussionsupporting

confidence: 89%

Disproportionate fluid sign as an aid in diagnosing high-grade bursal-sided supraspinatus tendon tear

et al. 2017

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“…According to the literature, patients with only supraspinatus calcific tendinopathy were symptomatic in 6 % of the cases [8][9][10]. Patients with supraspinatus calcific tendinopathy and pain had bursitis [Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Long-axis ultrasound image of supraspinatus tendon shows bursal surface tear, filled with echoic material (arrows) and SASD bursal moderate effusion extends from the bursal (superficial) surface to the articular (deep) surface of the tendon. Partial-thickness tears of the supraspinatus tendon include lesions of only the superficial or deep surface and tendon central delamination [8]. The superficial or bursal surface tears are associated with bursitis ( Fig.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study

et al. 2015

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Purpose The presence of the subacromial-subdeltoid (SASD) bursa inflammation has recently been proposed as a primary radiologic factor predicting persistent limitation and pain in operated patients. The aim of the study was to verify the hypothesis that pain, or increased shoulder pain, could be associated with SASD bursitis not only in operated patients but also in general population. Methods A consecutive series of 1940 shoulder ultrasound examinations were performed by our Department over a 5-year period using linear multi-frequency probes. All reports of examination executed for shoulder pain were reviewed. The video clips were independently reviewed by two radiologists: effusion in the SASD bursa and the presence of other pathological conditions were evaluated and confirmed. Results A total of 1147 shoulder video clips were reevaluated, and 1587 pathologies were detected; 65.5 % of patients had only one pathology, 30.4 % had two and 4.1 % presented three pathologies. The difference between the group with and without effusion is statistically significant for acromioclavicular joint arthritis, supraspinatus tendon calcific tendinopathy, full-thickness and superficial tear of the supraspinatus, traumas and rheumatoid arthritis with a p value \0.01. Conclusions Our study shows that the effusion in the SASD bursa is frequently associated with shoulder pain often independently from the underlying pathology; further studies are needed to confirm the statistical significance of this relationship by clarifying possible confounding factors.Keywords Ultrasound Á Subacromion-subdeltoid bursa Á Bursal inflammation Á Shoulder pain Riassunto Scopo del lavoro La presenza di alterazioni flogistiche a livello della borsa subacromiondeltoidea (BSAD) è stata recentemente proposta come fattore principale per predire la comparsa di dolore e limitazione funzionale nei Pazienti operati a livello della spalla. Lo scopo del nostro studio è di verificare l'ipotesi che il dolore, o l'incremento dello stesso, sia associato con la flogosi della BSAD non solo nei Pazienti operati ma anche nella popolazione generale. Materiali e Metodi In 5 anni nel nostro dipartimento sono state eseguite, utilizzando esclusivamente sonde lineari multifrequenza, 1940 ecografie della spalla. Tutti gli esami aventi come indicazione il dolore sono stati selezionati. I videoclip degli esami selezionati sono stati rivalutati da due radiologi indipendentemente: è stata in tal modo confermata la presenza di versamento nella BSAD e di altri reperti patologici. Risultati Sono stati rivalutati i videoclip di 1147 ecografie di spalla. Sono state individuate 1587 alterazioni patologiche; il 65.5 % dei Pazienti presentava unicamente un riscontro patologico, il 30.4 % ne presentava due e il 4.1 % ne presentava 3. La differenza tra gruppo con e senza versamento è statisticamente significativa (p value \0.01) in caso di artrosi acromionclaveare, tendinopatia calcifica del sovraspinato, lesioni a tutto spessore e del versante bursale del tendine del sovraspinato, ...

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“…An interstitial lesion is located between the two strings at the insertion. A cleavage tear is a gap running between the tendon fibers of the two strings (Figure 9, additional material) [18]. The infraspinatus muscle arises from the infraspinous fossa along the dorsal scapula.…”

Section: Rotator Cuffmentioning

confidence: 99%

Shoulder Anatomy and Normal Variants

Kadi

Milants²,

Shahabpour³

2017

Journal of the Belgian Society of Radiology

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The shoulder joint is functionally and structurally complex and is composed of bone, hyaline cartilage, labrum, ligaments, capsule, tendons and muscles. It links the trunk to the upper limb and plays an important biomechanical role in daily activities. Indications for imaging of the shoulder have considerably increased in the last few years. The article focuses mainly on Magnetic Resonance Imaging (MRI) as well as MR and CT arthrography, diagnostic procedures of choice for assessment of internal derangement of the shoulder. Bony components, rotator cuff tendons and muscles can be assessed on MR imaging without arthrographic technique, whereas the articular structures (including glenohumeral ligaments, capsulolabral structures and hyaline cartilage) require arthrography for more accurate assessment. Appropriate MR imaging protocols and sequences and applied MR anatomy of the shoulder (including normal variants) are proposed to help assist management and treatment of common shoulder pathologies encountered (such as rotator cuff tears, impingement syndromes, and instability as well as less frequent causes of shoulder pain). The most common variants and pitfalls are related to the anterosuperior aspect of the shoulder joint. Basic anatomy as well as recent findings are developed, including a new description of the attachment of supraspinatus and infraspinatus tendons at the superior aspect of the humerus, the rotator cable and the superior glenohumeral ligament complex.

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US appearance of partial-thickness supraspinatus tendon tears: Application of the string theory. Pictorial essay

Cited by 12 publications

References 21 publications

Disproportionate fluid sign as an aid in diagnosing high-grade bursal-sided supraspinatus tendon tear

Disproportionate fluid sign as an aid in diagnosing high-grade bursal-sided supraspinatus tendon tear

Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study

Shoulder Anatomy and Normal Variants

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