Original PaperDiagnostic accuracy of ultrasound for rotator cuff tears in adults: A systematic review and meta-analysis
Introduction
Rupture of the rotator cuff is a major cause of shoulder pain and associated functional disability,1, 2 with partial thickness tears a relatively common source of shoulder pain.3 Up to 70% of all shoulder pain is attributable to disorders of the rotator cuff.4, 5 Clinical examination is frequently considered difficult and unreliable as the location of shoulder pain is considered a poor indictor of its origin.6 Accordingly, radiological investigation is often required to confirm diagnosis.1, 7 The differential diagnosis of shoulder pathologies is further complicated as a number of different lesions, such as shoulder impingement syndrome and instability, can present with similar signs and symptoms.8, 9 As the diagnosis is important for determining treatment pathways, particularly differentiating between partial and full-thickness tears, an accurate diagnosis is required to ensure that the optimal management strategy is selected for these patients.1, 6, 10 In particular, accurate measurement of the size and location of rotator cuff tears is essential for effective preoperative planning.11
X-ray arthrography, magnetic resonance imaging (MRI), and ultrasonography have all been used to image the rotator cuff.1, 2, 8 Both X-ray arthrography and MRI can provide useful findings to assess the integrity of the rotator cuff but arthrography is an invasive procedure and may not be able to identify the size of the tear, and MRI is still relatively expensive and time-consuming.1 In comparison ultrasound is less expensive, less time-consuming, and permits a dynamic evaluation. Furthermore the portability of ultrasound means that the integrity of the rotator cuff can be assessed in geographically isolated locations or by a surgeon/radiologist during a clinic session to allow the efficient planning of treatment to be initiated.12
The first studies using ultrasound to detect rotator cuff tears were presented in the late 1970s.13 As the technology in high-frequency real-time ultrasound has developed, a number of studies have now been published assessing the diagnostic accuracy of ultrasound to detect partial or complete rotator cuff tear. Although some authors have suggested that there is little issue about the use of ultrasound for the diagnosis of full-thickness rotator cuff tears, there is greater controversy regarding the use of ultrasound for the diagnosis of partial-thickness tears.3, 14, 15 Three previous systematic reviews have been undertaken to assess the sensitivity of ultrasound for detecting these injuries.16, 17, 18 However, these studies only assessed English language publications, and either did not or made only limited attempts to assess sources of unpublished literature. Therefore, these findings may have been impacted by selection and publication biases. To address this, the purpose of the present study was to perform a systematic review of all literature to determine the diagnostic accuracy of ultrasound to detect partial and complete-thickness rotator cuff tears, based on all available clinical trials.
Section snippets
Eligibility criteria
All diagnostic accuracy studies that directly compared the accuracy of ultrasound (the index test) to either arthroscopic or open surgical findings (the reference test) for rotator cuff tears were included. All cadaveric and animal studies were excluded. No language restrictions were enforced. Studies based on patient age or methodological quality were not excluded. Studies that reported the diagnosis accuracy of either complete or partial tear were included, although these lesions were
Search result
In total, the search strategy identified 212 citations. On removing duplicates, the titles and abstracts indicated 82 papers were potentially eligible. Once the full texts of these citations were reviewed, 62 studies were deemed appropriate and fully satisfied the eligibility criteria for inclusion in the final review. The full results of the search strategy are presented in a PRISMA flowchart (Fig 1).
Methodology appraisal
The findings of the critical appraisal based on the QUADAS tool, is presented in Table 2. This
Discussion
The findings of this study indicate that although the diagnostic accuracy of ultrasound is acceptable for detecting rotator cuff tears, full-thickness rotator cuff tears are better detected by ultrasound compared to partial-thickness rotator cuff tears. The results of this analysis indicate that 7.5 MHz transducers may be better able to detect each type of rotator cuff tear, and that diagnostic accuracy was highest when ultrasonography was undertaken and reported by a musculoskeletal
Acknowledgements
The authors thank the library staff at the University of East Anglia’s library for their assistance in gathering the papers used in this systematic review. The authors also thank all corresponding authors who reviewed the findings of the search strategy of the present study.
References (91)
- et al.
Ultrasonography of the rotator cuff: analysis of results in a community setting
J Shoulder Elbow Surg
(1993) - et al.
Ultrasonographic and magnetic resonance images of rotator cuff lesions compared with arthroscopy or open surgery findings
J Shoulder Elbow Surg
(2001) - et al.
Accuracy of diagnostic ultrasound in patients with suspected subacromial disorders: a systematic review and meta-analysis
Arch Phys Med Rehabil
(2010) - et al.
PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
J Clin Epidemiol
(2009) - et al.
Distinction between supraspinatus, infraspinatus and subscapularis tendon tears with ultrasound in 332 surgically confirmed cases
Ultrasound Med Bio
(2002) - et al.
Comparison of shoulder ultrasound and MR imaging in diagnosing full-thickness rotator cuff tears
Clin Imaging
(2002) - et al.
The rotator crescent and rotator cable: an anatomic description of the shoulder’s "suspension bridge"
Arthroscopy
(1993) - et al.
Rotator cuff tears in asymptomatic individuals: a clinical and ultrasonographic screening study
Eur J Radiol
(2004) - et al.
Ultrasonography of symptomatic rotator cuff tears compared with MR imaging and surgery
Eur J Radiol
(2008) - et al.
Sonographic versus magnetic resonance arthrographic evaluation of full-thickness rotator cuff tears in millimeters
J Shoulder Elbow Surg
(2003)
Sonographic evaluation of the rotator cuff: correlation with arthroscopy
Arthroscopy
Shoulder ultrasound: diagnostic accuracy for impingement syndrome, rotator cuff tear, and biceps tendon pathology
J Shoulder Elbow Surg
Role of shoulder ultrasonography in the evaluation of the painful shoulder
Eur J Radiol
Evaluation of the symptomatic supraspinatus tendon—a comparison of ultrasound and arthroscopy
Radiography
Six surgery-correlated sonographic signs for rotator cuff tears: emphasis on partial-thickness tear
Clin Imaging
The use of in-office, orthopaedist-performed ultrasound of the shoulder to evaluate and manage rotator cuff disorders
J Shoulder Elbow Surg
Ultrasonography of the rotator cuff: a comparison with arthroscopy in one-hundred-and-ninety consecutive cases
Acta Radiol
Rotator cuff: evaluation with US and MR Imaging
RadioGraphics
Symptomatic partial rotator cuff tears: diagnostic performance of ultrasound and magnetic resonance imaging with surgical correlation
Acta Radiol
Predictors of chronic shoulder pain: a population based prospective study
J Rheumatol
Shoulder pain: diagnosis and management in primary care
BMJ
Accuracy of ultrasonography and magnetic resonance imaging for detection of full thickness rotator cuff tears
Int J Shoulder Surg
Diagnostic capabilities of shoulder ultrasonography in the detection of complete and partial rotator cuff tears
Am J Orthop
Sonographic evaluation of the rotator cuff. Accuracy in patients without prior surgery
Clin Orthop Relat Res
Ultrasonography in lesions of the rotator cuff and biceps tendon
Acta Radiol
Site and size of rotator-cuff tear. Findings at ultrasound, double-contrast arthrography, and computed tomography arthrography with surgical correlation
Invest Radiol
The detection of full thickness rotator cuff tears using ultrasound
J Bone Joint Surg Br
Arthrosonography: gray-scale ultrasound evaluation of the shoulder
Radiology
Sonography of the rotator cuff in painful shoulders performed without knowledge of clinical information: results from 58 sonographic examinations with surgical correlation
J Clin Ultrasound
The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review
Health Technol Assess
Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis
AJR Am J Roentgenol
Development and validation of methods for assessing the quality of diagnostic accuracy studies
Health Technol Assess
Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies
BMC Med Res Methodol
Systematic reviews of evaluations of diagnostic and screening tests
Estimating diagnostic accuracy from multiple conflicting reports: a new analytic method
Med Decis Making
Ultrasonography of the shoulder in subacromial syndromes with disorders and injuries of the rotator cuff
Orthopade
Introduction to medical statistics
Sonography and magnetic resonance imaging equivalent for the assessment of full thickness rotator cuff tears
Arthritis Rheum
Role of community diagnostic ultrasound examination in the diagnosis of full-thickness rotator cuff tears
ANZ J Surg
Musculoskeletal ultrasound training in rheumatology: the Belfast experience
Rheumatology
Ultrasonography for diagnosis of rotator cuff tear
Skeletal Radiol
Detection and quantification of rotator cuff tears: comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases
J Bone Joint Surg Am
Full-thickness and partial thickness supraspinatus tendon tears: value of US signs in diagnosis
Radiology
Musculoskeletal ultrasound
Rotator cuff sonography: a reassessment
Radiology
Cited by (133)
Age, Tear Size, Extent of Retraction, and Fatty Infiltration Associated With a High Chance of a Similar Rotator Cuff Tear in the Contralateral Shoulder Regardless of Symptoms in Patients Undergoing Cuff Repair in the Index Shoulder
2023, Arthroscopy - Journal of Arthroscopic and Related SurgeryFibrillar matrix, Echogenicity, Contour, Thickness, and Suture (FECTS) vs. Global: A comparison of 2 scales developed to assess ultrasound images post rotator cuff repair
2023, Journal of Shoulder and Elbow SurgeryHandheld Ultrasound Does not Replace Magnetic Resonance Imaging for Diagnosis of Rotator Cuff Tears
2023, Arthroscopy, Sports Medicine, and RehabilitationStates of contra-lateral rotator cuff – Based on bilateral shoulder ultrasound results of 401 patients
2023, Journal of Orthopaedic ScienceDiagnostic accuracy of examination tests for lateral elbow tendinopathy (LET) – A systematic review
2022, Journal of Hand Therapy