Original ArticlesUltrasonographic and magnetic resonance images of rotator cuff lesions compared with arthroscopy or open surgery findings*
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.
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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.
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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2016, Ultrasound in Medicine and BiologyUltrasound vs. MRI in the assessment of rotator cuff structure prior to shoulder arthroplasty
2015, Journal of OrthopaedicsCitation Excerpt :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.