Elsevier

Journal of Shoulder and Elbow Surgery

Volume 2, Issue 1, January–February 1993, Pages 22-26
Journal of Shoulder and Elbow Surgery

Ultrasonography of the rotator cuff: Analysis of results in a community setting

https://doi.org/10.1016/S1058-2746(09)80133-XGet rights and content

Forty-six patients underwent ultrasonogrophy evaluation of their shoulder for suspected rotator cuff tears from 1989 to 1992. All ultrasound studies were evaluated by a radiologist (HJH) who was not subspecialty-trained in shoulder ultrasonography. All patients had surgical confirmation of the status of their tendons. A statistical analysis of the accuracy of ultrasound in detecting rotator cuff tearing was performed. The sensitivity was 81%, and the specificity was 100%; there was a positive predictive value of 100% and a negative predictive value of 71%. Using strict sonographic criteria for diagnosing a rotator cuff tear, we conclude that ultrasound can detect intermediate or large rotator cuff tears with great accuracy (19 of 20 shoulders). Accuracy decreases dramatically in the presence of a small tear (six of 11 shoulders). At our hospital the cost of ultrasound examination of the shoulder is 0.19 the cost of magnetic resonance imaging of the shoulder and is 0.62 the cost of a shoulder arthrogrom. Ultrasound of the shoulder should be considered for imaging the rotator cuff because of its accuracy, low cost, and high patient satisfaction. It can be reliably performed by radiologists with state-of-the-art equipment who are interested in and have experience with the procedure.

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    In the present study, it was performed in the shoulder extension position for visualization of the SAB. In the extension position, the SAB is subjected to a strong compression force and the microvessels disappear; however, when evaluating the rotator cuff and SAB, it is recommended that the rotator cuff be examined in the shoulder extension position.7 Therefore, we should consider the observation position and area for the evaluation of hypervascularity of the SAB by US.

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    Friedman et al.9 also suggested that the number of false-negative findings may be related to the difference in criteria used for the diagnosis of a rotator cuff tear. For instance, some studies diagnosed focal thinning or fluid around the biceps tendon as a rotator cuff tear,37,46 whereas others have suggested that focal thinning or focal hyperechoic regions can be encountered frequently, and that these may not necessarily be pathological indicators of a rotator cuff tear.9 Finally, the time from ultrasound to surgery may have contributed to a number of false-negative findings with few studies reporting the time interval and variation (Table 2).

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