Original article
The use of in-office, orthopaedist-performed ultrasound of the shoulder to evaluate and manage rotator cuff disorders

https://doi.org/10.1016/j.jse.2004.01.017Get rights and content

Abstract

This study presents the use of in-office ultrasound, performed by an attending orthopaedic surgeon, as a means of evaluating the integrity of the rotator cuff. The results of 282 shoulder sonograms in patients ultimately treated surgically were included. Findings at surgery were recorded and compared with those documented during the ultrasound examination. Ultrasound findings included 118 full-thickness and 143 partial-thickness rotator cuff tears and 6 intact cuffs confirmed at surgery. One patient with a partial supraspinatus tear on ultrasound was intact at surgery, nine with complete supraspinatus tears had partial-thickness tears at surgery, one with an intact supraspinatus had a full-thickness tear at surgery, and four with partial-thickness supraspinatus tears had full-thickness tears at surgery. The sensitivity, specificity, positive predictive value, and negative predictive value were 94.1%, 96.1%, 96.6%, and 93.2%, respectively, for partial-thickness tears; 95.9%, 94.3%, 92.9%, and 96.8%, respectively, for full-thickness tears; and 99.6%, 85.7%, 99.6%, and 85.7%, respectively, when the rotator cuff was evaluated for damage (either partial- or full-thickness tears). This series documents the ability of an orthopaedic surgeon to image the rotator cuff effectively using portable ultrasound in the clinic setting, allowing for a more efficient implementation of the management plan.

Section snippets

Materials and methods

Four hundred fifty-one consecutive bilateral shoulder sonograms in four hundred six patients were obtained over a 3-year period. Of these, 282 shoulders were treated surgically in 262 patients. The findings of these 282 ultrasounds, for which the results were verified at surgery, were included in the study. There were 173 shoulders in men and 109 shoulders in women with a mean age of 50.4 years (range, 15-84 years).

A single orthopaedic surgeon in a busy clinic performed all of the ultrasound

Results

Ultrasound findings in the 282 surgical cases included 104 full-thickness supraspinatus tears, 148 partial-thickness supraspinatus tears, 14 full-thickness subscapularis tears, 9 full-thickness tears of the supraspinatus and subscapularis, and 7 intact rotator cuffs. At surgery, 95 full-thickness supraspinatus tendon tears were confirmed, as were 143 partial-thickness tears, all 14 subscapularis tears, all 9 combined supraspinatus and subscapularis tears, and 6 intact rotator cuffs. One patient

Discussion

In the early 20th century, Codman7 recognized the devastating effects that rotator cuff tears have on the individual patient and society in general. He believed that suboptimal results were due primarily to the fact that patients rarely presented at the early stages of disease. Today, early recognition as well as management of rotator cuff tears remains important. This includes documentation of the tear, which is often required by the patient, surgeon, and third-party payer before planning and

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