Elsevier

Journal of Shoulder and Elbow Surgery

Volume 10, Issue 5, September–October 2001, Pages 410-415
Journal of Shoulder and Elbow Surgery

Original Articles
Ultrasonographic and magnetic resonance images of rotator cuff lesions compared with arthroscopy or open surgery findings*

https://doi.org/10.1067/mse.2001.116515Get rights and content

Abstract

Our purpose was to compare the accuracy of ultrasonography (US) and magnetic resonance (MR) in the diagnosis of rotator cuff injuries (focusing on supraspinatus tears) using arthroscopy or open surgery findings. Using US and MR, we studied all painful shoulders seen during 1998 in our orthopaedic unit. Diagnosis was confirmed in 61 cases. The diagnosis of full thickness rotator cuff tear was highly specific on both imaging techniques (100% for US and 97.1% for MR) but was not as sensitive on US (57.7%) as on MR (80.8%). The diagnosis of partial tear was acceptably specific (67.9% for US and 75.5% for MR) but was not sensitive (overall, 12.5% for US vs 50% for MR). The specificity of a US diagnosis of a tear allows us to recommend surgery, thus making it a good imaging technique for the initial study of painful shoulders. The low sensitivity makes it necessary to undertake an additional MR study. If the MR also discovers no pathology, the sensitivity based on the US and MR images (92.7%) can be sufficient to avoid a false-negative diagnosis. (J Shoulder Elbow Surg 2001;10:410-5.)

Introduction

Shoulder impingement syndrome is due to the compression of the rotator cuff tendons and subacromial bursa between the humeral head and structures making up the coracoacromial arch. When slight, this mechanical compromise alters tendon fibers to produce tendinopathy, and when more severe and chronic, it can produce a partial or full thickness tear of the rotator cuff.5, 21, 24

The main noninvasive imaging modalities for diagnostic rotator cuff injuries are ultrasonography (US) and magnetic resonance (MR).2, 12 US is cheaper than MR, but the technique is so dependent on the experience of the operator with the equipment that the published results for sensitivity and specificity vary widely.11, 12, 17 MR gives excellent contrast between soft tissues and bone; as a result, degenerative changes and rotator cuff lesions, as well as other structural anomalies frequently associated with impingement, are more clearly seen on MR images than on US images.6, 21

The purpose of this study was to compare the accuracy of US and MR images in the diagnosis of rotator cuff injuries (focusing on supraspinatus tears) using arthroscopy or open surgery findings as the gold standard.

Section snippets

Materials and methods

During 1998, all painful shoulders seen in the orthopaedic unit of our University Hospital were prospectively studied with US and MR by 2 musculoskeletal radiologists. All patients were scanned after signed informed consent was obtained. One hundred forty shoulders were studied by US, but MR was not available in all cases. Diagnostic confirmation was obtained by arthroscopy or open surgery in those cases in which the patient had pain and limited movement, thus fulfilling the criteria for

Results

The US study depicted no abnormality in 6 shoulders (9.8%), tendinopathy in 17 (27.9%), calcifying tendinitis in 17 (27.9%), partial tear in 18 (29.5%), full tear in 15 (24.6%) (globally, tears affected 33 shoulders [54.1%]), and biceps tendon pathology in 8 (13.1%) (2 medial luxations and 6 cases of tendinitis). The US findings used to diagnose rotator cuff injuries are analyzed in Table I and illustrated in Figures 1, A, 2, 3, A, and 4.

. US findings as signs of rotator cuff pathology

Discussion

Approximately 60% of all shoulder pathology cases have been attributed to rotator cuff lesions, and arthroscopic studies suggest that 10% of cases of painful shoulder are due to full thickness tears, whereas the remaining 90% of cases would be due to partial tears, bursal thickenings, and tendinitis.24

At present, both US and MR are used for diagnosing tears at the rotator cuff, and neither is the clear method of choice.2, 19 However, the technical improvements in transducers and the fact that

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      Yet, not all of the seven partial tears were consistently described in US as two were classified as healthy tendons and another two as full-thickness tears. This inconsistency in the evaluation of partial-thickness tears has likewise been reported by other authors.5,12,13 Small partial-thickness tears can be missed whereas large focal defects over 50% of the tendon mimic full-thickness tears.8

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    *

    Reprint requests: Carmen Martín-Hervás, MD, Unit of Skeletal Radiology, La Paz University Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain.

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