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Wang Y, Zhu Y, Zhang F, Chen X, Chen J, Jiang W, Chen S, Yang J, Zhang Q. The value of combined ultrasound contrast arthrography and subacromial-subdeltoid bursography for detecting and differentiating the rotator cuff tear subtypes in patients with the uncertain rotator cuff tear. Eur Radiol 2024; 34:3503-3512. [PMID: 37855852 DOI: 10.1007/s00330-023-10183-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/14/2023] [Accepted: 07/30/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES In this study, ultrasound (US) contrast arthrography and subacromial-subdeltoid bursography with the contrast agent of SonoVue were performed to evaluate their value for detecting and differentiating the rotator cuff tear (RCT) subtypes in patients with the uncertain RCT. METHODS A total of 102 patients with the clinically suspected RCTs in the orthopedic clinic were prospectively recruited and underwent conventional high-frequency US for the category of undoubted full-thickness RCT, uncertain RCT, and intact rotator cuff. Among these patients, the patients with uncertain RCT underwent the subsequent US contrast arthrography and subacromial-subdeltoid bursography. The arthroscopic findings were used as the gold standard in this study. RESULTS After the conventional US screening, 62 patients with uncertain RCT underwent the subsequent US contrast arthrography and subacromial-subdeltoid bursography. All the US contrast arthrography and subacromial-subdeltoid bursography were successfully performed and no severe side effects were observed in all the patients. For full-thickness tears, the sensitivity and specificity of the combined US contrast arthrography and subacromial-subdeltoid bursography were 94.7% (CI: 0.72-1.0) and 81.4% (CI: 0.66-0.91), respectively, and for articular-side tears 100% (CI: 0.51-1) and 100% (CI: 0.92-1), respectively, and for the bursal-side tears 84.6% (CI: 0.54-0.97) and 97.9% (CI: 0.88-1.0), respectively. The main inconsistency between the contrast-enhanced US and arthroscopy was that 7 patients with arthroscopic proved concurrent articular- and bursal-side tears were indicated as full-thickness RCTs on contrast-enhanced US. CONCLUSIONS Combined US contrast arthrography and subacromial-subdeltoid bursography are useful for detecting the RCT subtypes in patients with the uncertain RCTs. CLINICAL RELEVANCE STATEMENT When conventional high-frequency US has some difficulty in differentiating the full-thickness from partial-thickness RCTs, combined US contrast arthrography and subacromial-subdeltoid bursography could be used to improve the detection accuracy of RCT subtypes. KEY POINTS • This is the first study by injection of the US contrast agent SonoVue into the shoulder joint cavity and subacromial-subdeltoid bursa for the detection and differentiation of the RCT subtypes among the people with the uncertain RCT by conventional US screening. • The SonoVue was injected into the glenohumeral joint cavity under US guidance to differentiate the full-thickness RCTs from partial-thickness RCTs. • Combined US contrast arthrography and subacromial-subdeltoid bursography are useful for detecting the RCT subtypes in patients with the uncertain RCTs.
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Affiliation(s)
- Yuexiang Wang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yaqiong Zhu
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Fei Zhang
- Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
| | - Xianghui Chen
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Jian Chen
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Wenli Jiang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Siming Chen
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Jing Yang
- Department of Pain Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
| | - Qiang Zhang
- Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China.
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Kim JH, Kwon OY, Hwang UJ, Jung SH, Gwak GT. Prediction Model of Subacromial Pain Syndrome in Assembly Workers Using Shoulder Range of Motion and Muscle Strength Based on Support Vector Machine. ERGONOMICS 2023:1-29. [PMID: 38039103 DOI: 10.1080/00140139.2023.2290983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/29/2023] [Indexed: 12/03/2023]
Abstract
Subacromial pain syndrome (SAPS) is the most common upper-extremity musculoskeletal problem among workers. In this study, a machine learning model was built to predict and classify the presence or absence of SAPS in assembly workers with shoulder joint range of motion (ROM) and muscle strength data using support vector machine (SVM). Permutation importance was used to determine important variables for predicting workers with or without SAPS. The accuracy of the support vector classifier (SVC) polynomial model for classifying workers with SAPS was 82.4%. The important variables in model construction were internal rotation and abduction of shoulder ROM and internal rotation of shoulder muscle strength. It is possible to accurately perform SAPS classification of workers with relatively easy-to-obtain shoulder ROM and muscle strength data using this model. In addition, preventing SAPS in workers is possible by adjusting the factors affecting model building using exercise or rehabilitation programs.
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Affiliation(s)
- Jun-Hee Kim
- Yeonsedae-gil, Maeji-ri, Heungeop-myeon, Wonju-si, Gangwon-do, 26493, Laboratory of KEMA AI Research (KAIR), Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
| | - Oh-Yun Kwon
- Yeonsedae-gil, Maeji-ri, Heungeop-myeon, Wonju-si, Gangwon-do, 26493, Laboratory of Kinetic Ergocise Based on Movement Analysis, Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
| | - Ui-Jae Hwang
- Yeonsedae-gil, Maeji-ri, Heungeop-myeon, Wonju-si, Gangwon-do, 26493, Laboratory of KEMA AI Research (KAIR), Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
| | - Sung-Hoon Jung
- Baekseokdaehak-ro, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 31065, Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan, South Korea
| | - Gyeong-Tae Gwak
- Yeonsedae-gil, Maeji-ri, Heungeop-myeon, Wonju-si, Gangwon-do, 26493, Laboratory of KEMA AI Research (KAIR), Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
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Nalbant MO, Inci E. The Efficiency of Gray-Level Ultrasound Histogram Analysis in Patients with Supraspinatus Tendinopathy. Niger J Clin Pract 2023; 26:1709-1715. [PMID: 38044777 DOI: 10.4103/njcp.njcp_325_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/09/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Musculoskeletal ultrasonography is a viable substitute for magnetic resonance imaging (MRI) that offers advantages in terms of time efficiency and cost-effectiveness. The gray-level histogram is a tool used to depict the distribution of pixel gray levels that provide quantitative data. AIM The objective of our research was to establish a threshold value for ultrasonography-measured supraspinatus tendon gray-level values by comparing patients with tendinopathy to those without. MATERIALS AND METHODS This study comprised a cohort of 271 individuals, consisting of 124 patients diagnosed with supraspinatus tendinopathy and 147 cases without the aforementioned condition who underwent shoulder MRI and ultrasound examinations. Two radiologists independently conducted the gray-level histogram analyses. The histogram parameters were determined, including the mean, minimum, median, maximum, fifth, 10th, 25th, 50th, 75th, 90th, and 95th percentiles, as well as skewness, kurtosis, and variance. The interobserver agreement was evaluated using the interclass correlation coefficient. RESULTS The supraspinatus tendinopathy group's all gray-level values were lower than those of the control group, and the difference was statistically significant (P < .05). The supraspinatus tendinopathy group exhibited greater values of skewness and kurtosis in comparison to the control group (P < .05). The area under the curve of the 95th percentile of the gray-level value was the highest (area under the curve = 0.960; cut-off value = 82.5; sensitivity = 96.7%; specificity = 88.2%). CONCLUSION The analysis of the histogram of gray-level values has the potential to be a promising method for the monitoring of patients with supraspinatus tendinopathy. This approach could be considered a feasible alternative to MRI.
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Affiliation(s)
- M O Nalbant
- Department of Radiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Murphy RJ, Bintcliffe F. Ask the expert: assessment of shoulder pain in primary care. BMJ 2023; 382:1255. [PMID: 37419617 DOI: 10.1136/bmj.p1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
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Wang T, Guo J, Mi Y, Xiao Z, Yin B, Lu B, Deng H. States of contra-lateral rotator cuff - Based on bilateral shoulder ultrasound results of 401 patients. J Orthop Sci 2023:S0949-2658(23)00135-5. [PMID: 37330353 DOI: 10.1016/j.jos.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/05/2023] [Accepted: 05/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND For patients with rotator cuff tear (RCT), the contra-lateral shoulders have higher risk of RCT than general population. It has been proved by several previous studies. The focus of this study is to obtain the data of contra-lateral rotator cuff tear in Chinese population, and to find the rules of contra-lateral rotator cuff tear through statistical analysis. METHODS From March 2016 to January 2020, patients who underwent shoulder arthroscopic surgery were included in the study, we conduct bilateral shoulder ultrasound before surgery, patients information collection include gender, age, occupation and whether received contra-lateral rotator cuff surgery within 1-3 years. The above information was statistically analyzed. RESULTS According to the inclusion and exclusion criteria, 401 patients were included. The incidence of contra-lateral rotator cuff tear was 24.3%, 5.58% of them underwent contra-lateral rotator cuff repair surgery within 3 years. The degree of contra-lateral rotator cuff tear was positively correlated with the degree of the primary side; Patients with full-thickness rotator cuff tear were more likely to have contra-lateral rotator cuff tear than patients with partial rotator cuff tear. For patients with supraspinatus tendon tear, the contra-lateral rotator cuff tear risk increases, For patients with subscapularis muscle tear, the contra-lateral rotator cuff tear risk doesn't increases. Contra-lateral rotator cuff tear is related to age, the risk of contra-lateral rotator cuff tear is higher in elderly patients. CONCLUSIONS The contra-lateral RCT data obtained in our study was 24.3%, significantly lower than that of previous studies. The reasons may include ethnic variation, lifestyle, and proportion of heavy physical labor. The condition of contra-lateral rotator cuff is closely related to affected side rotator cuff tear.
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Affiliation(s)
- Tianci Wang
- Department of Orthopaedic Trauma, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Jialiang Guo
- Department of Orthopaedic Trauma, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Yaru Mi
- Department of Ultrasonography, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Zeng Xiao
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Bing Yin
- Department of Orthopaedic Trauma, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Bo Lu
- Department of Orthopaedic Trauma, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China.
| | - Heping Deng
- Department of Ultrasonography, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China.
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Williams TG, Hackett LM, Lam PH, Stitz DJ, Al-Housni H, Murrell DF, Murrell GAC. Fibrillar matrix, Echogenicity, Contour, Thickness, and Suture (FECTS) vs. Global: A comparison of 2 scales developed to assess ultrasound images post rotator cuff repair. J Shoulder Elbow Surg 2023; 32:713-728. [PMID: 36481456 DOI: 10.1016/j.jse.2022.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ultrasound is commonly used to assess rotator cuff repair (RCR), but no standardized criterion exists to characterize the tendon. PURPOSE The aims of this study were to (1) develop content validity for ultrasound specific criteria to grade the postoperative appearance of a tendon after RCR, (2) assess the reliability of the criteria, and (3) assess the feasibility to use these assessments. METHODOLOGY Following expert consultation and literature review for content validity, 2 scales were created: 1) the Fibrillar matrix, Echogenicity, Contour, Thickness, and Suture (FECTS) scale and 2) the Rotator Cuff Repair-Investigator Global Assessment (RCR-IGA). A prospective cohort study was undertaken on patients who had received a RCR and serial B-mode ultrasound images. Four raters assessed the 64-ultrasound images using the scales created in a blinded fashion using intraclass correlation coefficients. RESULTS The FECTS scale was a composite score with 5 key parameters and the RCR-IGA scale was a 5-point global score. The intrarater reliability for the FECTS scale was excellent for the most experienced rater (0.92) and fair for the rater with no experience (0.72). The intrarater reliability for the RCR-IGA scale was excellent for 3 of the 4 raters (0.80-0.87) and fair when used by the least experienced rater (0.56). Inter-rater testing for all the FECTS scale parameters had excellent reliability (0.82-0.92) except for Fibrillar matrix (0.73). The average time to complete the FECTS scale per image was 23 seconds and 11 seconds for the RCR-IGA scale. CONCLUSION The FECTS scale and the RCR-IGA scale are reliable tools to assess the ultrasonic appearance of the repaired rotator cuff tendon. The FECTS scale was more reliable for less experienced assessors. The RCR-IGA scale was easier, more time efficient and reliable for those with experience.
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Affiliation(s)
- Tiffany G Williams
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Lisa M Hackett
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Patrick H Lam
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Daniel J Stitz
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Hilal Al-Housni
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Dedee F Murrell
- Department of Dermatology, St. George Hospital, Sydney, NSW, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia.
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van der Kraats AM, Peeters NH, Janssen ER, Lambers Heerspink FO. Handheld Ultrasound Does not Replace Magnetic Resonance Imaging for Diagnosis of Rotator Cuff Tears. Arthrosc Sports Med Rehabil 2023; 5:e381-e387. [PMID: 37101874 PMCID: PMC10123419 DOI: 10.1016/j.asmr.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/12/2022] [Accepted: 01/04/2023] [Indexed: 03/05/2023] Open
Abstract
Purpose The purpose of this study was to examine the reliability and validity of handheld ultrasound (HHUS) alone versus conventional ultrasound (US) or magnetic resonance imaging (MRI) for diagnosis of rotator cuff tears and versus MRI plus computed tomography (CT) for diagnosis of fatty infiltration. Methods Adult patients with shoulder complaints were included in this study. HHUS of the shoulder was performed twice by an orthopedic surgeon and once by a radiologist. RCTs, tear width, retraction and FI were measured. Inter- and intrarater reliability of the HHUS was calculated using a Cohen's kappa coefficient. Criterion and concurrent validity were calculated using a Spearman's correlation coefficient. Results Sixty-one patients (64 shoulders) were included in this study. Intra-rater agreement of HHUS for assessment of RCTs (к = 0.914, supraspinatus) and FI (к = 0.844, supraspinatus) was moderate to strong. Interrater agreement was none to minimal for the diagnosis of RCTs (к = 0.465, supraspinatus) and FI (к = 0.346, supraspinatus). Concurrent validity of HHUS compared to MRI was fair for diagnosis of RCTs (r = 0.377, supraspinatus) and fair-to-moderate FI (r = 0.608, supraspinatus). HHUS shows a sensitivity of 81.1% and specificity of 62.5% for diagnosis of supraspinatus tears, 60% and 93.1% for subscapularis tears, 55.6% and 88.9% for infraspinatus tears. Conclusions On the basis of findings in this study, we conclude that HHUS is an aid in diagnosis of RCTs and higher degrees of FI in patients who are not obese, but it does not replace MRI as the gold standard. Further clinical studies on the application of HHUS comparing HHUS devices in larger patient populations and healthy patients are required to identify its utility in clinical practice. Level of Evidence Level III.
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Yoon TH, Kim SJ, Choi YR, Kang KT, Chun YM. 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. Arthroscopy 2023:S0749-8063(23)00174-3. [PMID: 36804457 DOI: 10.1016/j.arthro.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/26/2023] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To investigate the prevalence of a contralateral rotator cuff tear (RCT) in patients with a symptomatic RCT requiring repair and to determine whether findings from magnetic resonance imaging (MRI) of the affected shoulder can predict the presence of a contralateral tear. METHODS Patients with atraumatic RCTs who had undergone arthroscopic repair between March 2019 and February 2021 were reviewed in this study. MRI of both shoulder joints was performed to evaluate the bilaterality of RCT. Demographic factors and MRI findings of index shoulders were assessed using logistic regression analysis to reveal any correlations with the presence of RCT in the contralateral shoulder. RESULTS A total of 428 patients were enrolled in this study. When the affected shoulders had a posterosuperior rotator cuff (PSRC) or subscapularis tear including either an isolated or combined tear, 63.6% and 67.8% had the same tears on the contralateral side, respectively. A contralateral-side tear was found in 74.6% (185/248) of symptomatic cases and 44.8% (65/145) of asymptomatic cases, which represents a significant difference (P < .001). Logistic regression analysis revealed that age ≥67.5 years, tear size ≥17 mm, Goutallier grade ≥1.5, and Patte grade ≥1.5 were found to be indicative of potential contralateral PSRC tears. By contrast, the presence of a subscapularis tear in the affected shoulder was the only significant risk factor in predicting a potential subscapularis tear in the contralateral shoulder. CONCLUSIONS Among patients with a symptomatic RCT requiring arthroscopic repair, 63.6% with a PSRC tear and 67.8% with a subscapularis tear in the affected shoulder were found to have a similar tear in the contralateral shoulder regardless of symptoms. Age, tear size, extent of retraction, fatty infiltration of PSRC tears, and the presence of subscapularis tears were identified as factors predictive of tears on the contralateral side. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Tae-Hwan Yoon
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Jae Kim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Tae Kang
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Wahba MM, Selim M, Hegazy MM, Elgohary R, Abdelsalam MS. Eccentric Versus Concentric Exercises in Patients With Rheumatoid Arthritis and Rotator Cuff Tendinopathy: A Randomized Comparative Study. Ann Rehabil Med 2023; 47:26-35. [PMID: 36792052 PMCID: PMC10020054 DOI: 10.5535/arm.22150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE To determine the efficacy of concentric vs. eccentric exercise in improving shoulder function, pain, and tendon characteristics for patients with rheumatoid arthritis and rotator cuff tendinopathy. METHODS Forty patients with rheumatoid arthritis and rotator cuff tendinopathy were divided into either concentric or eccentric exercise groups, with 20 patients in each group. Patients received 12 sessions at a pace of 3 sessions per week. Shoulder Pain and Disability Index (SPADI), the visual analogue scale (VAS), supraspinatus and subscapularis thickness, echo pixels, and the Disease Activity Score-28-erythrocyte sedimentation rate (DAS-28-ESR) were assessed at baseline and post-treatment. RESULTS There was a significant difference between the concentric and eccentric groups regarding SPADI and VAS scores in favor of the eccentric group. However, there was no significant difference between the two groups regarding tendon thickness, echo pixels, or DAS-28-ESR. CONCLUSION Eccentric exercises were more effective than concentric exercises in improving shoulder function and pain intensity. However, neither of the two types of exercises was superior in improving tendon characteristics or disease activity.
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Affiliation(s)
- Mina Magdy Wahba
- Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Badr University in Cairo, Cairo, Egypt
- Corresponding author: Mina Magdy Wahba Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Badr University in Cairo, Entertainment Area, Badr City, Cairo 11829, Egypt. Tel: +20-01285170876, Fax: +20-28650400, E-mail:
| | - Mona Selim
- Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Badr University in Cairo, Cairo, Egypt
| | - Mohammed Moustafa Hegazy
- Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Rasmia Elgohary
- Rheumatology and Clinical Immunology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mohammed Shawki Abdelsalam
- Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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Drakonaki EE, Martinoli C, Vanhoenacker FM, Detoraki A, Dalili DE, Adriaensen M. The Beauty of Musculoskeletal Ultrasound: Spot Diagnoses. ROFO-FORTSCHR RONTG 2023; 195:385-392. [PMID: 36630982 DOI: 10.1055/a-1965-9961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Ultrasound is a powerful technique in musculoskeletal (MSK) imaging, and it can replace MR imaging in many specific clinical scenarios. This article will feature some common and less common spot diagnoses in musculoskeletal ultrasound. SPOT DIAGNOSIS Cases were collected by members of the Educational Committee of the ESSR ( European Society of Musculoskeletal Radiology) with expertise in musculoskeletal ultrasound. Sixteen clinical entities are discussed based on the features that allow US spot diagnosis. CONCLUSION Clinical history, location, and ultrasound appearance are the keys to spot diagnoses when performing musculoskeletal ultrasound. KEY POINTS · Musculoskeletal ultrasound can be the primary and only modality in common spot diagnoses in specific clinical settings.. · Clinical history, location, and ultrasound appearance are keys to spot diagnoses.. · Knowledge of spot diagnoses in musculoskeletal ultrasound facilitates daily clinical practice.. CITATION FORMAT · Drakonaki EE, Martinoli C, Vanhoenacker FM et al. The Beauty of Musculoskeletal Ultrasound: Spot Diagnoses. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1965-9961.
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Affiliation(s)
- Elena E Drakonaki
- Department of Anatomy, University of Crete School of Medicine, Heraklion, Greece.,Department of MSK imaging, Diagnostic and Interventional Ultrasound Practice, Heraklion, Greece
| | - Carlo Martinoli
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Filip Maria Vanhoenacker
- Department of Radiology, University Hospital Antwerp, Edegem (Antwerp), Belgium.,Department of Radiology, AZ Sint-Maarten Duffel-Mechelen, Belgium
| | - Anna Detoraki
- Medical School, Comenius University in Bratislava, Slovakia
| | - Daniel E Dalili
- Department of Radiology, Southend University Hospital, Mid and South Essex NHS Trust, Essex, United Kingdom of Great Britain and Northern Ireland
| | - Miraude Adriaensen
- Department of Medical Imaging, Zuyderland Medical Center, Heerlen, Netherlands
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11
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Hinsley H, Ganderton C, Arden NK, Carr AJ. Prevalence of rotator cuff tendon tears and symptoms in a Chingford general population cohort, and the resultant impact on UK health services: a cross-sectional observational study. BMJ Open 2022; 12:e059175. [PMID: 36100305 PMCID: PMC9472112 DOI: 10.1136/bmjopen-2021-059175] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To define the population prevalence of rotator cuff tears and test their association with pain and function loss; determine if severity symptom correlates with tear stage severity, and quantify the impact of symptomatic rotator cuff tears on primary healthcare services in a general population cohort of women. DESIGN Cross-sectional observational study. PARTICIPANTS Individuals were part of the Chingford 1000 Women cohort, a 20-year-old longitudinal population study comprising 1003 women aged between 64 and 87, and representative of the population of the UK. MAIN OUTCOME MEASURES Rotator cuff pathology prevalence on ultrasound, shoulder symptoms using the Oxford Shoulder Score and resultant number of general practitioner (GP) consultations. RESULTS The population prevalence of full-thickness tears was 22.2%, which increased with age (p=0.004) and whether it was the dominant arm (Relative Risk 1.64, OR 1.58, 95% CI 1.07 to 2.33, p=0.021).Although 48.4% of full-thickness tears were asymptomatic, there was an association between rotator cuff tears and patient-reported symptoms. Individuals with at least one full-thickness tear were 1.97 times more likely than those with bilateral normal tendons (OR 3.53, 95% CI 2.00 to 5.61, p<0.001) to have symptoms. Severity of symptoms was not related to the severity of the pathology until tears are >2.5 cm (p=0.009).In the cohort, 8.9% had seen their GP with shoulder pain and a full-thickness rotator cuff tear, 18.8% with shoulder pain and an abnormality and 29.3% with shoulder pain. CONCLUSION Rotator cuff tears are common, and primary care services are heavily impacted. As 50% of tears remain asymptomatic, future research may investigate the cause of pain and whether different treatment modalities, aside from addressing the pathology, need further investigation.
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Affiliation(s)
- Hannah Hinsley
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Charlotte Ganderton
- Nursing and Allied Health, Swinburne University of Technology Faculty of Health Arts and Design, Hawthorn, Victoria, Australia
| | - Nigel K Arden
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew J Carr
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Duijn EAHD, Roy van S, Karel YHJM, Provyn S, Pouliart N. An interexaminer agreement and reliability study on cadavers with musculoskeletal ultrasound of the shoulder performed by physiotherapists and radiologists compared with dissection. Musculoskelet Sci Pract 2022; 60:102569. [PMID: 35533597 DOI: 10.1016/j.msksp.2022.102569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 04/20/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A cross-sectional inter-examiner agreement and reliability study on fresh frozen cadaver shoulders. BACKGROUND Musculoskeletal ultrasound (MSU) is frequently used by physical therapists and radiologists to improve specific diagnosis in rotator cuff related pathology. The evaluation of the rotator cable seems to be important as stabilizing structure when cuff tears occur. OBJECTIVES To evaluate the inter-examiner agreement and reliability of MSU of the shoulder to detect rotator cuff-pathology and the involvement of the rotator cable in comparison to "dissection". METHODS Physical therapists, a radiologist and an orthopedic surgeon (dissection) investigated 40 fresh frozen cadaver shoulders in order to detect shoulder pathology including rotator cable involvement. Examiners were blinded to each other's findings. RESULTS We found a strong and significant agreement between the raters: PTs, the radiologist and the dissector in this cadaver study for all rotator cuff, the long head of the biceps pathologies and in detecting abnormalities of the rotator cable. The kappa value was substantial to (almost) perfect agreement for all diagnostic outcome categories. CONCLUSIONS This study shows that among a limited group of physical therapists, one radiologist and a dissector a strong level of agreement with kappa values from substantial to (almost) perfect in finding subacromial pathology.
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Affiliation(s)
- E A H D Duijn
- Basic (bio) Medical Sciences (BMWE), Vrije Universiteit Brussel, Brussels, Belgium.
| | - S Roy van
- Vrije Universiteit van Brussel, Brussels, Belgium
| | - Y H J M Karel
- Research Group Life in Motion, Avans University of Applied Sciences, Breda, the Netherlands
| | - S Provyn
- Basic (bio) Medical Sciences (BMWE), Vrije Universiteit Brussel, Brussels, Belgium; Anatomical Research and Clinical Studies (ARCS) Vrije Universiteit Brussel, Brussels, Belgium
| | - N Pouliart
- Basic (bio) Medical Sciences (BMWE), Vrije Universiteit Brussel, Brussels, Belgium; Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel) Brussels, Belgium
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13
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Gallagher V, Buchanan J, Harris J, McCrum C. Audit: sonographic report correlation against surgical findings during elective shoulder surgery. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:141-148. [PMID: 35509294 PMCID: PMC9058382 DOI: 10.1177/1742271x211033314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/28/2021] [Indexed: 05/03/2023]
Abstract
Introduction Musculoskeletal diagnostic ultrasound is an expanding clinical tool and increasingly used at point of care in clinical practice. Criticism around the accuracy of this modality is often attributed to operator dependence. This study evaluated the accuracy of a sonographer's reporting against shoulder surgery. Methods A musculoskeletal sonographer performed same-day ultrasound scans prior to elective shoulder surgery procedures. The sonographer was blinded to clinical history and previous investigations. A brief physical examination of resisted external rotation and resisted abduction strength was performed prior to scanning. Scan results were reported using British Elbow and Shoulder Society (BESS) reporting criteria. The sonographer attended surgery to gain immediate visual feedback. Sonographic reports and magnetic resonance imaging (MRI) reports were graded (1= complete agreement; 2 = minor discrepancy unlikely to alter patient care; 3 = potentially significant discrepancy; 4 = definite, significant discrepancy) against surgical findings. The accuracy of sonographic reporting was correlated with patients' body mass index (BMI). Results Fifty-four cases were compared and correlations evaluated. Grade 1 (complete agreement) was reported 87.0% (n = 47), Grade 2 (minor discrepancy) 9.3% (n = 5) and Grade 3 (potentially significant discrepancy) 3.7% (n = 2). Sonographic reports closely correlated (Grade 1 or 2 scores) with surgical findings in 96% of cases. Conclusions The musculoskeletal sonographic reporting had a high correlation with surgery findings. Ultrasound was more accurate than MRI in reporting full thickness rotator cuff tears. Clinical weakness in resisted external rotation or abduction did not correlate with imaging. Ultrasound was found to be unreliable in detecting rotator cuff tears in participants with a BMI ≥ 35.
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Affiliation(s)
- Vincent Gallagher
- Vincent Gallagher, East Sussex Healthcare NHS Trust, The Garden Room Education Centre, Saint Leonards-on-Sea, East Sussex TN37 7RD, UK.
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Comparative Analysis of Real-Time Dynamic Ultrasound and Magnetic Resonance Imaging in the Diagnosis of Rotator Cuff Tear Injury. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:2107693. [PMID: 34887929 PMCID: PMC8651368 DOI: 10.1155/2021/2107693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
Abstract
Objective To explore the value of real-time dynamic ultrasound and magnetic resonance imaging (MRI) in the diagnosis of rotator cuff injury. Methods From January 2020 to June 2021, the clinical data of 55 patients with rotator cuff injury were collected. All patients were examined by real-time dynamic ultrasound and MRI at the same time within two weeks before surgery, which was confirmed by arthroscopy. The value of real-time dynamic ultrasound, MRI, and the real-time dynamic ultrasound combined with MRI in the diagnosis of rotator cuff injury was evaluated. Results Among the 55 patients with rotator cuff injury, real-time dynamic ultrasound showed full-thickness rotator cuff tear in 12 patients (21.82%), including type I in 2 patients (3.64%), type II in 6 patients (10.91%), and type III in 4 patients (7.27%), and partial rotator cuff tear in 31 patients (56.36%), including type IV in 16 patients (29.00%), type V in 5 patients (9.09%), and type VI in 10 patients (18.18%). MRI showed full-thickness rotator cuff tear in 12 patients (21.82%), including type I in 2 patients (3.64%), type II in 6 patients (10.91%), and type III in 4 patients (7.27%), and partial rotator cuff tear in 37 patients (67.27%), including type IV in 20 patients (36.36%), type V in 7 patients (12.73%), and type VI in 10 patients (18.18%). The combined examination showed full-thickness rotator cuff tear in 12 patients (21.82%), including type I in 2 patients (3.64%), type II in 6 patients (10.91%), and type III in 4 patients (7.27%), and partial rotator cuff tear in 39 cases (70.91%), including type IV in 21 cases (38.12%), type V in 7 patients (12.73%), and type VI in 12 patients (21.82%). The diagnostic accuracy of real-time dynamic ultrasound in complete tearing, partial tearing and the overall accuracy were 92.31%, 73.81% and 78.18%, respectively. The diagnostic accuracy of complete tear, partial tear and the overall accuracy of MRI were 92.31%, 88.00% and 89.09%, respectively. The diagnostic accuracy of complete tear and partial tear and overall accuracy in the real-time dynamic ultrasound combined with MRI were 92.31%, 95.24%, and 94.55%, respectively. The diagnostic accuracy and overall diagnostic accuracy of the combined examination of partial tears were higher than those of the real-time dynamic ultrasound and MRI examinations alone. Conclusion Real-time dynamic ultrasound and MRI have high application value in the diagnosis of rotator cuff injury, and the combined diagnosis is conducive to improving the diagnostic accuracy of patients with partial tear.
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Selame LAJ, Matsas B, Krauss B, Goldsmith AJ, Shokoohi H. A Stepwise Guide to Performing Shoulder Ultrasound: The Acromio-Clavicular Joint, Biceps, Subscapularis, Impingement, Supraspinatus Protocol. Cureus 2021; 13:e18354. [PMID: 34725606 PMCID: PMC8553233 DOI: 10.7759/cureus.18354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/12/2022] Open
Abstract
Shoulder pain is a common and painful patient condition. Unfortunately, diagnostic imaging of shoulder pain in the emergency department (ED) is often limited to radiography. While diagnostic for fractures and dislocations, drawbacks of radiography include time delays and non-diagnostic imaging in the case of rotator cuff pathology. While bedside ultrasound has been incorporated into many procedural and diagnostic applications in the ED, its use for musculoskeletal complaints and specifically shoulder pain is infrequent among ED clinicians. The incorporation of shoulder ultrasound in the ED may improve diagnostic certainty while decreasing time to diagnosis and treatment, yielding patient and health system benefits. Herein, we present the ABSIS (Acromio-clavicular joint, Biceps, Subscapularis, Impingement, Supraspinatus) Protocol for performing bedside ultrasound of the shoulder including the rotator cuff and bony anatomy.
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Affiliation(s)
| | | | - Benjamin Krauss
- Renaissance School of Medicine, Stony Brook University, Stony Brook, USA
- Emergency Department, Massachusetts General Hospital, Boston, USA
| | | | - Hamid Shokoohi
- Emergency Department, Massachusetts General Hospital, Boston, USA
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Diagnostic Accuracy of Musculoskeletal Ultrasound on Long Head Biceps Tendon Pathologies. J Sport Rehabil 2021; 30:1098-1101. [PMID: 34006667 DOI: 10.1123/jsr.2020-0511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/12/2021] [Accepted: 03/18/2021] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Pathologies of the long head of the biceps brachii (LHB) tendon are a source of shoulder pain in many people. It is important to have a reliable assessment of the LHB tendon to make an accurate diagnosis and provide the correct treatment or referral if necessary. Shoulder ultrasound is very accurate in the diagnosis of rotator cuff tears. However, its ability to detect pathologies of the LHB tendon is still unclear. Clinical Question: In patients with shoulder pain, can musculoskeletal ultrasound accurately diagnose LHB tendon pathologies? Summary of Key Findings: Four high-quality cohort studies met inclusion criteria and were included in the critical appraisal. The STrengthening the Reporting of OBservational studies in Epidemiology checklist was used to score the articles on methodology and consistency. Three studies evaluated accuracy in diagnosis of full-thickness tears and found high sensitivity (SN) and specificity (SP). Three studies evaluated accuracy in diagnosis of partial-thickness tears and found low SN and negative predictive value, but high SP and positive predictive value. Two studies evaluated tendon subluxation/dislocation and found high SN and SP. Two studies evaluated tendinitis and found moderate SN and high SP. Clinical Bottom Line: There is moderate to strong evidence to support the use of musculoskeletal ultrasound in diagnosis of LHB tendon pathology. Strength of Recommendation: There is grade B evidence that musculoskeletal ultrasound can accurately diagnose full-thickness tears and tendon subluxation/dislocation; can rule in partial-thickness tears (based on SP and positive predictive value), but not rule out partial-thickness tears; and can rule in tendinitis (based on SP and positive predictive value), but not rule out tendinitis.
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A. Hamid MS, Sazlina SG. Platelet-rich plasma for rotator cuff tendinopathy: A systematic review and meta-analysis. PLoS One 2021; 16:e0251111. [PMID: 33970936 PMCID: PMC8109792 DOI: 10.1371/journal.pone.0251111] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/20/2021] [Indexed: 01/01/2023] Open
Abstract
Shoulder rotator cuff tendinopathy is a common debilitating condition that affects a person daily function and the quality of life. Despite its frequent occurrence, the best treatment is still inconclusive. This review assessed the clinical effect of platelet-rich plasma injection for rotator cuff tendinopathy. A systematic literature search was conducted using CINAHL, Medline, SCOPUS, SPORTSDiscus and Web of Science databases to retrieve articles published in peer-reviewed journals until December 2020. Randomised controlled trials (RCTs), which compared clinical effects of PRP injection to the usual care among adults diagnosed with rotator cuff conditions were reviewed. The main outcomes of interest were changes in shoulder pain symptoms and shoulder functions. All variables were analysed using random effects meta-analyses. Eight RCTs were reviewed in this study. The risk of bias for randomization was low for 6 RCTs, one study had unclear risk and the other was a high risk. Studies vary on the PRP techniques including preparation and injections. Moreover, the control intervention also differs. Four studies compared PRP with normal saline injection while in the remaining 4 RCTs the control intervention were rehabilitation program and dry needling. Meta-analysis of selected studies showed that PRP injection was safe and effective intervention for long-term pain control and shoulder function in patients with RC disorders.
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Affiliation(s)
| | - Shariff Ghazali Sazlina
- Faculty of Medicine and Health Sciences, Department of Family Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- * E-mail:
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Xu D, Song R, Zhu T, Tu J, Zhang D. Quantitative Evaluation of Rotator Cuff Tears Based on Non-linear Statistical Analysis of Ultrasound Radiofrequency Signals. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:582-589. [PMID: 33317856 DOI: 10.1016/j.ultrasmedbio.2020.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/30/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
There is increasing clinical requirement for early and accurate ultrasound diagnosis of rotator cuff tears (RCTs). A method based on non-linear statistical analysis was proposed for the detection of RCTs using ultrasound radiofrequency (RF) signals. One hundred fifty-two patients with shoulder pain were first examined with ultrasound and then diagnosed with magnetic resonance imaging (MRI) as the ground truth. By comparison of the region of interest (ROI) with a part of the supraspinatus with no pathologic change part in the same RF signal frame, the relative Pks value (viz., rPks value) was evaluated to quantify the pathophysiologic changes. The results indicated that the rPks values of all RCTs are <0.7, and the accuracy, sensitivity and specificity of the proposed method can reach 97.5%, 100% and 91.4%, respectively. This computer-aided method was found to perform better diagnostic than the results reported by an experienced radiologist (accuracy = 75.7%, sensitivity = 72.6%, and specificity = 85.7%). The high sensitivity advantage of this method indicates that the prospects for its application in the computer-aided diagnosis of RCTs are good.
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Affiliation(s)
- Dahua Xu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Renjie Song
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing, China
| | - Tianshu Zhu
- First Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Juan Tu
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing, China
| | - Dong Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing, China.
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Karanasios S, Korakakis V, Moutzouri M, Drakonaki E, Koci K, Pantazopoulou V, Tsepis E, Gioftsos G. Diagnostic accuracy of examination tests for lateral elbow tendinopathy (LET) - A systematic review. J Hand Ther 2021; 35:541-551. [PMID: 33814224 DOI: 10.1016/j.jht.2021.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/24/2021] [Accepted: 02/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reviews on the diagnostic performance of the examination tests for lateral elbow tendinopathy (LET) based on updated context-specific tools and guidelines are missing. PURPOSE To review the diagnostic accuracy of examination tests used in LET. DESIGN Systematic review following PRISMA-DTA guidelines. METHODS We searched MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, and Cochrane Library databases. The QUADAS-2 checklist was used to assess the methodological quality of the eligible studies. We included diagnostic studies reporting the accuracy of physical examination tests or imaging modalities used in patients with LET. RESULTS Twenty-four studies with 1370 participants were identified reporting the diagnostic performance of Ultrasound Imaging (USI) (18 studies), physical examination tests (2 studies) and Magnetic Resonance Imaging (MRI) (4 studies). Most studies (97%) were assessed with "unclear" or "high risk" of bias. Sonoelastography showed the highest sensitivity (75- 100%) and specificity (85- 96%). Grayscale with or without Doppler USI presented poor to excellent values (sensitivity: 53%-100%, specificity: 42%-90%). MRI performed better in the diagnosis of tendon thickening and enthesopathy (sensitivity and specificity: 81%-100%). The Cozen's test reported high sensitivity (91%) while a grip strength difference of 5%-10% between elbow flexion and extension showed high sensitivity (78%-83%) and specificity (80%-90%). CONCLUSIONS Cozen's test and grip strength measurement present high accuracy in the diagnosis of LET but are poorly investigated. USI and MRI provide variable diagnostic accuracy depending on the entities reported and should be recommended with caution when differential diagnosis is necessary. Substantial heterogeneity was found in inclusion criteria, operator/ examiner, mode of application, type of equipment and reference standards across the studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID CRD42020160402.
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Affiliation(s)
| | | | - Maria Moutzouri
- Physiotherapy Department, University of West Attica, Egaleo, Greece
| | - Eleni Drakonaki
- Medical School of the European University Cyprus, Engomi, Nicosia Cyprus
| | - Klaudia Koci
- Physiotherapy Department, University of West Attica, Egaleo, Greece
| | | | - Elias Tsepis
- Physiotherapy Department, University of Patras, Greece
| | - George Gioftsos
- Physiotherapy Department, University of West Attica, Egaleo, Greece
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Diagnostic ultrasound in patients with shoulder pain: An inter-examiner agreement and reliability study among Dutch physical therapists. Musculoskelet Sci Pract 2021; 51:102283. [PMID: 33348286 DOI: 10.1016/j.msksp.2020.102283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 09/07/2020] [Accepted: 10/27/2020] [Indexed: 01/16/2023]
Abstract
STUDY DESIGN A cross-sectional inter-examiner agreement and reliability study among physical therapists in primary care. BACKGROUND musculoskeletal ultrasound (MSU) is frequently used by physical therapists to improve specific diagnosis in patients with shoulder pain, especially for the diagnosis rotator cuff tendinopathy (RCT) including tears. OBJECTIVES To estimate the inter-examiner agreement and reliability in physical therapists using MSU for patients with shoulder pain. METHODS Physical therapists performed diagnostic MSU in 62 patients with shoulder pain. Both physical therapists were blinded to each other's results and patients were not informed about the test results. We calculated the overall inter-examiner agreement, specific positive and negative inter-examiner agreement, and inter-examiner reliability (Cohen's Kappa's). RESULTS Overall agreement for detecting RC ruptures ranged from 61.7% to 85.5% and from 43.9% to 91.4% for specific positive agreement. The specific negative agreement was lower with values ranging from 44.4% to 79.1% for RC ruptures. Overall agreement for other pathology than ruptures related to SAPS, ranged from 72.6% to 93.6% and from 77.3% to 96% for specific positive agreement. The specific negative agreement was lower with values ranging from 44.4% to 79.1% for RC ruptures and 52.5%-83.3% for other pathology than ruptures related to SAPS. Reliability values varied from substantial for any thickness ruptures to moderate for partial thickness ruptures and fair for full thickness tears. Moreover, reliability was fair for cuff tendinopathy. The reliability for AC arthritis and no pathology found was fair and moderate. There was substantial agreement for the calcifying tendinopathy. CONCLUSIONS Physical therapists using MSU agree on the diagnosis of cuff tendinopathy and on the presence of RCT in primary care, but agree less on the absence of pathology.
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21
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Vopat ML, Peebles LA, McBride T, Cirone I, Rider D, Provencher CMT. Accuracy and Reliability of Imaging Modalities for the Diagnosis and Quantification of Hill-Sachs Lesions: A Systematic Review. Arthroscopy 2021; 37:391-401. [PMID: 32798670 DOI: 10.1016/j.arthro.2020.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/24/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the reliability and accuracy of different imaging modalities in assessing Hill-Sachs lesions within the setting of anterior shoulder instability. METHODS A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using the PubMed, Scopus, Embase, and Cochrane Library databases. The inclusion criteria were clinical trials or cadaveric studies that assessed the accuracy of humeral head bone loss imaging or reliability and English-language articles. The exclusion criteria were animal studies; imaging studies without measures of accuracy, reliability, or clinical predictive power; studies of shoulder injuries without humeral head bone loss; editorials; abstracts; reviews; case reports; and surveys. The search terms included "imaging" OR "radiographic" OR "CT" OR "MRI" AND "Hill-Sachs" OR "humeral head bone loss." Assessment of the methodologic quality of the included studies was performed using the original Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. RESULTS Forty studies (2,560 shoulders) met the inclusion criteria and were assessed. For diagnosing the presence of Hill-Sachs lesions, computed tomography (CT) arthrography had the highest reported accuracy (median, 91%; range, 66%-100%). For the same assessment, CT arthrography also had the greatest reported sensitivity (median, 94%; range, 50%-100%). For the quantification of Hill-Sachs lesion parameters, reported intraobserver reliabilities were highest for 3-dimensional (3D) CT (intraclass correlation coefficient [ICC] range, 0.916-0.999), followed by 2-dimensional CT (ICC range, 0.858-0.861) and magnetic resonance imaging (MRI) (ICC range, 0.28-0.97). For the same quantification parameters, interobserver reliabilities were also reported for 3D CT (ICC range, 0.772-0.996), 2-dimensional CT (ICC range, 0.721-0.879), and MRI (κ range, 0.444-0.700). Intraobserver reliabilities for determining glenoid tracking were only reported for 3D CT (κ range, 0.730-1.00; ICC range, 0.803-0.901) and MRI (ICC range, 0.770-0.790). CONCLUSIONS This study shows that the current literature supports a variety of different imaging modalities that provide clinically acceptable accuracy in diagnosing and quantifying Hill-Sachs lesions, as well as determining whether they will cause persistent anterior shoulder instability. Furthermore, this systematic review justifies that further research is needed to help develop a treatment algorithm on the proper imaging modalities needed to help treat patients with anterior shoulder instability that is both reliable and financially acceptable. LEVEL OF EVIDENCE Level IV, systematic review of Level I through IV studies.
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Affiliation(s)
- Matthew L Vopat
- University of Kansas School of Medicine-Wichita, Wichita, Kansas, U.S.A
| | - Liam A Peebles
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Trevor McBride
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, U.S.A
| | - Isaak Cirone
- Colorado State University, Fort Collins, Colorado, U.S.A
| | - Danielle Rider
- Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Capt Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A..
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Abstract
PURPOSE OF REVIEW This review presents epidemiology, etiology, management, and surgical outcomes of rotator cuff injuries in tennis players. RECENT FINDINGS Rotator cuff injuries in tennis players are usually progressive overuse injuries ranging from partial-thickness articular- or bursal-sided tears to full-thickness tears. Most injuries are partial-thickness articular-sided tears, while full-thickness tears tend to occur in older-aged players. The serve is the most energy-demanding motion in the sport, and it accounts for 45 to 60% of all strokes performed in a tennis match, putting the shoulder at increased risk of overuse injury and rotator cuff tears. Studies have shown deficits in shoulder range of motion and scapular dyskinesia to occur even acutely after a tennis match. First-line treatment for rotator cuff injuries in any overhead athlete consists of conservative non-operative management with appropriate rest, anti-inflammatory drugs, followed by a specific rehabilitation program. Operative treatment is usually reserved for older-aged players and to those who fail to return to play after conservative measures. Surgical options include rotator cuff debridement with or without tendon repair, biceps tenodesis, and labral procedures. Unlike rotator cuff repairs in the general population, repairs in the elite tennis athlete have less than ideal rates of return to sport to the same level of performance. Rotator cuff injuries are a common cause of pain and dysfunction in tennis players and other overhead athletes. The etiology of rotator cuff tears in tennis players is multifactorial and usually results from microtrauma and internal impingement in the younger athlete leading to partial tearing and degenerative full-thickness tears in older players. Surgical treatment is pursued in athletes who are still symptomatic despite an extensive course of non-operative treatment as outcomes with regard to returning to sport to the same pre-injury level are modest at best. Debridement alone is usually preferred over rotator cuff repairs for partial tears in younger players due to potential over-constraining of the shoulder joint and decreased rates of return to sport after rotator cuff repairs.
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Affiliation(s)
- Rami G. Alrabaa
- Department of Orthopedic Surgery, Columbia University Medical Center, 622 W 168th Street, PH-11, New York, NY 10032 USA
| | - Mario H. Lobao
- Department of Orthopedic Surgery, Columbia University Medical Center, 622 W 168th Street, PH-11, New York, NY 10032 USA
| | - William N. Levine
- Department of Orthopedic Surgery, Columbia University Medical Center, 622 W 168th Street, PH-11, New York, NY 10032 USA
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Yoon K, Kim H, Han SB, Song HS. Ultrasound Findings Aid Decisions to Repair Partial Articular Supraspinatus Tendon Avulsion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2005-2011. [PMID: 32324303 DOI: 10.1002/jum.15307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Ultrasound (US) is useful for diagnosing full-thickness rotator cuff tears and high-grade partial-thickness bursal-side tears. However, anisotropy artifacts make it difficult to identify partial articular supraspinatus tendon avulsion (PASTA) by US. This study was performed to determine the diagnostic accuracy of US for PASTA and to uncover sensitive findings that could aid decisions to repair. METHODS Patients who underwent preoperative US examinations and supraspinatus tendon confirmation by arthroscopic examinations were enrolled. We analyzed 52 PASTA cases involving greater than 50% thickness of the tendon and 52 age- and sex-matched cases with an intact supraspinatus. Two orthopedic surgeons blinded to the diagnosis interpreted US videos of the supraspinatus tendon. Six findings (echo defect, tendon delamination, echo change, tendon thickness, tendon fiber pattern, and cartilage interface sign) were assessed. We calculated the sensitivity, specificity, and accuracy for each US finding. RESULTS The cases consisted of 46 men and 58 women. The US diagnosis of PASTA showed sensitivity of 64.7%, specificity of 94.1%, and accuracy of 79.4%. The echo change in the short axis showed the highest sensitivity. Thinning and delamination showed the highest specificity of 100%. In contrast to previous reports, the sensitivity of the cartilage interface sign was low in both long-axis images (17.6%) and short-axis images (29.4%). CONCLUSIONS Preoperative diagnostic US to aid decisions regarding PASTA repair showed high specificity (94.1%) and moderate accuracy (79.4%). However, the sensitivity was only 64.7% and was affected by the examiner's experience with US.
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Affiliation(s)
- Kisyck Yoon
- Department of Orthopedic Surgery, Eunpyeong St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Hyungsuk Kim
- Department of Orthopedic Surgery, Eunpyeong St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Sung Bin Han
- Department of Orthopedic Surgery, Eunpyeong St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Hyun Seok Song
- Department of Orthopedic Surgery, Eunpyeong St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
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Tat J, Tat J, Theodoropoulos J. Clinical applications of ultrasonography in the shoulder for the Orthopedic Surgeon: A systematic review. Orthop Traumatol Surg Res 2020; 106:1141-1151. [PMID: 32763009 DOI: 10.1016/j.otsr.2020.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/04/2020] [Accepted: 06/01/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ultrasound imaging offers a non-invasive method to visualize the anatomy and function of the musculoskeletal system. Despite its benefits and widespread adoption in medicine, ultrasonography is still not well utilized by orthopaedic surgeons. The purpose of this systematic review was to provide a better understanding of the diagnostic accuracy and clinical utility of ultrasound of the shoulder for orthopaedic surgeons. METHODS We searched Medline, Embase, Web of Science, and Scopus databases. Our search terms included orthopedic, orthopedic surgery, ultrasonography, and shoulder. Inclusion criteria consisted of studies that used bedside ultrasound for the diagnosis and therapy of patients with common clinical entities of the shoulder presenting to orthopedic clinics, to demonstrate the utility for orthopedic surgeons. We reported sensitivity, specificity, positive predictive value, negative predictive value. Studies were excluded if they used non-diagnostic ultrasound modalities (e.g. shock wave therapy, shear wave elastography, Doppler flowmetry, speckle tracking shear strain, vibro-acoustography). RESULTS Our search strategy yielded 771 of potentially relevant publications, 41 studies were retrieved for full text screening, and 24 were included in this systematic review. We found that ultrasound used in orthopedic clinics has good sensitivity and high specificity for the assessment of partial and full rotator cuff tears of the shoulder, including post-operative cuff repairs. There was some evidence that it may also be useful for the diagnosis of subacromial-subdeltoid bursitis, AC joint arthropathy, and labral tears; however further investigations are still required. Ultrasound improves that accuracy of injections into spaces of the shoulder (subacromial bursa, acromioclavicular joint, glenohumeral joints, and the long head of biceps tendon sheath) compared to landmark guided injections, that can be helpful for diagnostic purposes, but do not improve long term clinical outcomes. DISCUSSION We reviewed the literature for orthopaedic surgeons and show that ultrasound of the shoulder can be a useful diagnostic tool for orthopedic surgeons in outpatient clinics. We found no difference in sensitivity or specificity when ultrasound was performed at bedside by orthopedic surgeons or by radiologists for patients referred to orthopedic clinic.
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Affiliation(s)
- Jimmy Tat
- Division of Orthopedic Surgery, University of Toronto, Toronto, Canada
| | - Jessica Tat
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
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Ferrer GA, Miller RM, Yoshida M, Wang JH, Musahl V, Debski RE. The Correlation of Quantitative Ultrasound Measures and Supraspinatus Tendon Quality: A Pilot Study. J Med Ultrasound 2020; 28:162-168. [PMID: 33282660 PMCID: PMC7709527 DOI: 10.4103/jmu.jmu_104_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/12/2019] [Accepted: 12/23/2019] [Indexed: 11/07/2022] Open
Abstract
Background: The objective of this study was to determine the feasibility of assessing tendon quality as quantified by histology through changes in quantitative ultrasound measures. Methods: Eight cadaveric shoulders (four with a small supraspinatus tendon tear) were examined using conventional B-mode ultrasound in the transverse plane by internally rotating and hyperextending the humerus. Quantitative ultrasound measures (skewness, kurtosis, variance, and echogenicity) were calculated based on the grayscale distribution of the ultrasound image taken of the supraspinatus tendon near the insertion site. The specimens were then dissected to the supraspinatus tendon where tendon biopsies were taken near the insertion site, mid-substance, and myotendinous junction. Through histology, tendon quality was evaluated based on collagen fiber organization, fatty infiltration, nuclei shape, and cellularity. Correlations between quantitative ultrasound measures and histological grades of tendon quality were determined through Pearson or Spearman's rho correlations. Results: A total of three significant correlations between quantitative ultrasound measures and histological parameters of tendon quality were found. Significant correlations between kurtosis and cellularity at the insertion site (r = 0.724) (P < 0.05) as well as variance and fatty infiltration at the myotendinous junction (ρ = −0.843) (P < 0.05) and for the whole tendon (ρ = −0.826) (P < 0.05) were found. Conclusion: The results show the potential for quantitative ultrasound measures to assess factors of tendon quality that can only be determined through histology. With further development of the methodology that utilizes quantitative ultrasound measures, clinicians might be able to evaluate the tendon quality noninvasively in future.
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Affiliation(s)
- Gerald A Ferrer
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - R Matthew Miller
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Masahito Yoshida
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James H Wang
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard E Debski
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Mills FB, Williams K, Chu CH, Bornemann P, Jackson JB. Prevalence of Abnormal Ultrasound Findings in Asymptomatic Posterior Tibial Tendons. Foot Ankle Int 2020; 41:1049-1055. [PMID: 32567358 DOI: 10.1177/1071100720931085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Posterior tibial tendon dysfunction (PTTD) is a pathological condition that can cause failure of the posterior tibial tendon (PTT). Initially, patients with PTTD are often asymptomatic, making early identification and treatment challenging. Certain ultrasound (US) characteristics have been implicated in the presence of tendinopathy, but their frequency has yet to be assessed in the PTT. The purpose of this study was to identify and report on the frequency of incidental, or potentially early subclinical, tendinopathic US characteristics in asymptomatic PTTs. METHODS Following institutional review board approval, 150 participants underwent a bilateral-comprehensive US assessment. The resulting images were reviewed and assessed to identify the presence of abnormalities demonstrated to represent tendinopathy. RESULTS Overall, 266 tendons were assessed and 128 (48.1%) were determined to have at least one tendinopathic trait. Specifically, 51 (19.2%) had circumferential fluid, 69 (25.9%) had noncircumferential fluid, 22 (8.3%) had thickening, 31 (11.7%) had heterogenicity, 19 (7.1%) had hyperemia, and 2 (0.8%) had calcification. Additionally, Caucasian participants were found to be nearly 3 times more likely to have tendinopathic findings when compared with African American participants. CONCLUSION Sixty-seven percent of participants and 48.1% of PTTs evaluated had at least one tendinopathic feature identified on US. The prevalence rates of these findings, observed in participants, were as follows: noncircumferential fluid, circumferential fluid, heterogenicity, and thickening. Knowing the frequency of these traits may help clinicians to identify subclinical tendinopathy in the PTT before it progresses to PTTD. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- F Baker Mills
- Palmetto Health-USC Orthopaedic Center, Columbia, SC, USA
| | - Kevin Williams
- Palmetto Health-USC Orthopaedic Center, Columbia, SC, USA
| | | | - Paul Bornemann
- Palmetto Health-USC Family Medicine Center, Columbia, SC, USA
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Kooijman MK, Swinkels ICS, Koes BW, de Bakker D, Veenhof C. One in six physiotherapy practices in primary care offer musculoskeletal ultrasound - an explorative survey. BMC Health Serv Res 2020; 20:246. [PMID: 32209091 PMCID: PMC7092536 DOI: 10.1186/s12913-020-05119-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/18/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The first aim of this research was to investigate the current prevalence of musculoskeletal ultrasound in Dutch physiotherapy practices. The second aim was to explore experiences of physiotherapists with musculoskeletal ultrasound in a primary care setting with patients presenting with shoulder complaints. METHODS A random sample of 1000 owners of primary care physiotherapy practices was sent a questionnaire to investigate the prevalence of musculoskeletal ultrasound. A second questionnaire was sent to physiotherapists using musculoskeletal ultrasound to explore experiences with it in patients with shoulder complaints. RESULTS The net response rate of the first questionnaire was 57.7%. In 18% of the physiotherapy practices musculoskeletal ultrasound was offered. Sixty-nine physiotherapists returned the second questionnaire. Physiotherapists indicated they most often used musculoskeletal ultrasound in patients with shoulder complaints, mainly for suspected tissue damage (83.7%), followed by making a diagnosis (63.3%) and for determining the choice of treatment (36.7%). Physiotherapists reported the biggest advantage was that they were better able to diagnose presenting shoulder complaints. The most frequently mentioned disadvantage of the use of musculoskeletal ultrasound was that assessment is difficult and that there is a risk that findings may not be sufficiently linked to history and physical examination. CONCLUSION One in six physiotherapy practices in the Netherlands offer musculoskeletal ultrasound. It is mainly used for patients with shoulder complaints, with an emphasis on detecting tissue damage and as an aid for diagnosis. Physiotherapists trained to work with musculoskeletal ultrasound seem enthusiastic and are at the same time aware of its disadvantages.
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Affiliation(s)
- Margit K. Kooijman
- Department of Allied Health Care, NIVEL Netherlands Institute of Health Services Research, PO BOX 1568, 3500 BN Utrecht, the Netherlands
| | - Ilse C. S. Swinkels
- Department of Allied Health Care, NIVEL Netherlands Institute of Health Services Research, PO BOX 1568, 3500 BN Utrecht, the Netherlands
| | - Bart W. Koes
- Department of General Practice, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Dinny de Bakker
- Department of Allied Health Care, NIVEL Netherlands Institute of Health Services Research, PO BOX 1568, 3500 BN Utrecht, the Netherlands
- Scientific Centre for Transformations in Care and Welfare (TRANZO), Tilburg University, Tilburg, the Netherlands
| | - Cindy Veenhof
- Department of Rehabilitation, Nursing Sciences and Sport, University Medical Center Utrecht, Utrecht, the Netherlands
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Treatment of large, massive irreparable rotator cuff tears. КЛИНИЧЕСКАЯ ПРАКТИКА 2020. [DOI: 10.17816/clinpract18925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The rotator cuff is a complex anatomical and biomechanical structure which allows stabilization of the shoulder joint in the correct position and movements in it. The rotator cuff tears remain the most frequent injury as compared to those of other anatomical structures of the shoulder joint and reach the incidence of 21%, according to a number of authors. Such injuries are prone to inducing a fat replacement of muscle tissues in elderly patients against the background of degenerative changes in the structure of the rotator cuff. These injuries are hard-to-heal, and the incidence of relapses after the surgical treatment reaches 2090%, according to several authors. Based on the investigation of the postoperative treatment failures, alternative methods for the replacement, transfer or surgical repair of damaged tendons are adopted, but there is still no single approach and method in the treatment of this pathology. In this literature review, we have analyzed the data on the anatomical structure and biomechanics of the rotator cuff, the role of the rotator cuff damage in the dysfunction of the shoulder joint and possible methods for its recovery.
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Liu F, Dong J, Shen WJ, Kang Q, Zhou D, Xiong F. Detecting Rotator Cuff Tears: A Network Meta-analysis of 144 Diagnostic Studies. Orthop J Sports Med 2020; 8:2325967119900356. [PMID: 32076627 PMCID: PMC7003181 DOI: 10.1177/2325967119900356] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many imaging techniques have been developed for the detection of rotator cuff tears (RCTs). Despite numerous quantitative diagnostic studies, their relative accuracy remains inconclusive. PURPOSE To determine which of 3 commonly used imaging modalities is optimal for the diagnosis of RCTs. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Studies evaluating the performance of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and ultrasound (US) used in the detection of RCTs were retrieved from the PubMed/MEDLINE and Embase databases. Diagnostic data were extracted from articles that met the inclusion/exclusion criteria. A network meta-analysis was performed using an arm-based model to pool the absolute sensitivity and specificity, relative sensitivity and specificity, and diagnostic odds ratio as well as the superiority index for ranking the probability of these techniques. RESULTS A total of 144 studies involving 14,059 patients (14,212 shoulders) were included in this network meta-analysis. For the detection of full-thickness (FT) tears, partial-thickness (PT) tears, or any tear, MRA had the highest sensitivity, specificity, and superiority index. For the detection of any tear, MRI had better performance than US (sensitivity: 0.84 vs 0.81, specificity: 0.86 vs 0.82, and superiority index: 0.98 vs 0.22, respectively). With regard to FT tears, MRI had a higher sensitivity and superiority index than US (0.91 vs 0.87 and 0.67 vs 0.28, respectively) and a similar specificity (0.88 vs 0.88, respectively). The results for PT tears were similar to the detection of FT tears. A sensitivity analysis was performed by removing studies involving only 1 arm for FT tears, PT tears, or any tear, and the results remained stable. CONCLUSION This network meta-analysis of diagnostic tests revealed that high-field MRA had the highest diagnostic value for detecting any tear, followed by low-field MRA, high-field MRI, high-frequency US, low-field MRI, and low-frequency US. These findings can help guide clinicians in deciding on the appropriate imaging modality.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Jinlei Dong
- Department of Orthopedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Wun-Jer Shen
- Po Cheng Orthopedic Institute, Kaohsiung, Taiwan
| | - Qinglin Kang
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Dongsheng Zhou
- Department of Orthopedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Fei Xiong
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- Fei Xiong, MD, Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Yishan Road 600, Xuhui District, Shanghai 200233, China ()
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Lin BS, Chen JL, Tu YH, Shih YX, Lin YC, Chi WL, Wu YC. Using Deep Learning in Ultrasound Imaging of Bicipital Peritendinous Effusion to Grade Inflammation Severity. IEEE J Biomed Health Inform 2020; 24:1037-1045. [PMID: 31985446 DOI: 10.1109/jbhi.2020.2968815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Inflammation of the long head of the biceps tendon is a common cause of shoulder pain. Bicipital peritendinous effusion (BPE) is the most common biceps tendon abnormality and is related to various shoulder injuries. Physicians usually use ultrasound imaging to grade the inflammation severity of the long head of the biceps tendon. However, obtaining a clear and accurate ultrasound image is difficult for inexperienced attending physicians. To reduce physicians' workload and avoid errors, an automated BPE recognition system was developed in this article for classifying inflammation into the following categories-normal and mild, moderate, and severe. An ultrasound image serves as the input in the proposed system; the system determines whether the ultrasound image contains biceps. If the image depicts biceps, then the system predicts BPE severity. In this study, two crucial methods were used for solving problems associated with computer-aided detection. First, the faster regions with convolutional neural network (faster R-CNN) used to extract the region of interest (ROI) area identification to evaluate the influence of dataset scale and spatial image context on performance. Second, various CNN architectures were evaluated and explored. Model performance was analyzed by using various network configurations, parameters, and training sample sizes. The proposed system was used for three-class BPE classification and achieved 75% accuracy. The results obtained for the proposed system were determined to be comparable to those of other related state-of-the-art methods.
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Aguado G, Obando DV, Herrera GA, Ramirez A, Llinás PJ. Retears of the Rotator Cuff: An Ultrasonographic Assessment During the First Postoperative Year. Orthop J Sports Med 2019; 7:2325967119889049. [PMID: 31903401 PMCID: PMC6927200 DOI: 10.1177/2325967119889049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Surgical repair of rotator cuff (RC) tears is an effective treatment option. However, the prevalence of recurrent ruptures is high. Hypothesis Recurrent tears are a frequent complication of surgical repair of RC tears. Their incidence might be influenced by factors such as the patient's age and size of the initial tear. Study Design Case series; Level of evidence, 4. Methods Data from 90 adult patients who underwent arthroscopic RC repair between 2014 and 2017 and underwent an ultrasound examination 6 to 12 months after surgery were analyzed retrospectively. Massive tears were repaired using a double-row technique, and nonmassive tears were repaired with a single-row technique. Clinical records were reviewed for demographic information. Results All patients (57.8% women; 42.2% men) were older than 18 years (mean, 58.9 years). Of these patients, 30.0% (27/90) had massive tears, which were primarily found in patients ≥60 years (74.1%; 20/27). Complete healing was seen in 74.5% of all repairs during follow-up. A total of 23 patients (25.5%) had retears (13 complete; 10 partial), which were diagnosed by ultrasound imaging 6 to 12 months after the initial surgery. The occurrence of retears was more prevalent in patients with massive tears than in patients with nonmassive tears (40.7% vs 19.0%, respectively); the difference was statistically significant (P = .03). Reruptures occurred in 50.0% of patients older than 60 years with massive tears. Although patients older than 60 years had more recurrent tears (32.6%) compared with younger patients (18.2%), the difference was not statistically significant (P = .12). Conclusion One-quarter of the patients who had undergone surgical repair of an RC tear had recurrent ruptures. There was a statistically significant association between the initial massive tear and a retear. Patients older than 60 years showed a higher recurrence rate, but this difference lacked statistical significance. Reruptures occurred in 50.0% of patients older than 60 years with massive tears.
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Affiliation(s)
| | | | - Gilberto A Herrera
- Icesi University, Cali, Colombia.,Orthopedics Department, Fundación Valle del Lili, Cali, Colombia
| | | | - Paulo J Llinás
- Icesi University, Cali, Colombia.,Orthopedics Department, Fundación Valle del Lili, Cali, Colombia.,Fellowship Program in Arthroscopic and Reconstructive Surgery of the Shoulder and Knee, Fundación Valle del Lili, Cali, Colombia
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Hirahara AM, Andersen WJ, Panero AJ. Ultrasound Assessment of the Superior Capsular Reconstruction With Dermal Allograft: An Evaluation of Graft Thickness and Vascularity. Arthroscopy 2019; 35:3194-3202. [PMID: 31785745 DOI: 10.1016/j.arthro.2019.06.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/18/2019] [Accepted: 06/22/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess postoperative changes in the thickness of the dermal allograft of the superior capsular reconstruction (SCR) and to evaluate the graft for the presence of intrasubstance pulsatile vessels. METHODS A retrospective chart review was conducted to identify SCR patients who had ultrasound evaluations between May 2014 and February 2019. Data were collected and stratified based on time from surgery into 2 groups: 0 to 12 months and past the 12-month follow-up. The primary outcome measure was graft thickness at the articular margin-greater tuberosity interface (tuberosity measurement). Secondary measures included midsubstance graft thicknesses 0.5, 1.0, and 1.5 cm medial to the tuberosity measurement; status of lateral graft fixation; presence of pulsatile vessels; and American Shoulder and Elbow Society and visual analog scale scores. RESULTS Eighteen patients were included for analysis. The tuberosity measurement at final follow-up (mean 25 months, range 12-40 months) was (mean ± standard error [95% confidence interval (CI)]) 4.4 ± 0.2 mm (95% CI 4.0-4.8). This differed significantly from the midsubstance measurements: 0.5 cm: 3.6 ± 0.2 mm (95% CI 3.3-4.0, P = .008); 1.0 cm: 3.1 ± 0.2 mm (95% CI 2.7-3.4, P < .001); and 1.5 cm: 2.9 ± 0.2 mm (95% CI 2.6-3.2, P < .001). Ten constructs (56%) showed signs of pulsatile vessels in the first 12 months and all constructs were intact. ASES scores improved from 49.3 ± 4.0 (95% CI 41.6-57.1) preoperatively to 85.1 ± 2.9 (95% CI 79.4-90.8) (P < .001), and VAS scores decreased from 5.3 ± 0.6 (95% CI 4.2-6.5) preoperatively to 0.9 ± 0.3 (95% CI 0.3-1.5) at final follow-up (P < .001). CONCLUSIONS The SCR dermal allograft significantly thickens at its lateral aspect, presents with evidence of vasculature in most patients in the first year of implantation, and is not resorbed by the body. LEVEL OF EVIDENCE Level IV - therapeutic case series.
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Abstract
With the high cost and limited availability of gold standard imaging modalities, ultrasound has become an alternative in many musculoskeletal (MSK) injuries. Ultrasound has become increasingly portable and readily available in many acute care settings. Its ability to diagnose MSK injuries and help guide management has the potential to improve patient safety and flow. Ultrasound has been shown to diagnose fractures, dislocations, and tendon and ligament injuries. It helps guide fracture and dislocation reductions and aids in regional anesthesia for pain management. This article reviews the common MSK injuries that can be diagnosed with ultrasound with a focus on point-of-care ultrasound.
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Affiliation(s)
- Robert Simard
- Emergency Department, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue C7-53, Toronto, Ontario M4N 3M5, Canada; Emergency Department, North York General Hospital, Toronto, Ontario, Canada.
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Abdelzaher MG, Tharwat S, AbdElkhalek A, Abdelsalam A. Ultrasound versus magnetic resonance imaging in the evaluation of shoulder joint pathologies in a cohort of rheumatoid arthritis patients. Int J Rheum Dis 2019; 22:2158-2164. [PMID: 31670481 DOI: 10.1111/1756-185x.13728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/22/2019] [Accepted: 09/30/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a systemic autoimmune disease that has a great impact on different joints, may result in their destruction and loss of function. Although the shoulder is affected in a large portion of patients with RA, it does not receive much attention during the follow up of RA. The precise diagnosis of shoulder pain in RA is a clinical challenge and benefits from a reliable imaging modality to detect its exact origin. AIM To determine the diagnostic accuracy of ultrasound (US) in detecting shoulder joint pathologies in RA, considering magnetic resonance imaging (MRI) as the gold standard. MATERIALS AND METHODS This cross-sectional, observational study was carried out on 30 RA patients complaining of unilateral or bilateral shoulder pain. Patients were subjected to history taking, clinical shoulder examination, plain X-ray, US examination following a standardized protocol, and MRI. The results were correlated with each other. RESULTS In comparison with the MRI findings, US showed high accuracy in terms of sensitivity (Sn) and specificity (Sp) in supraspinatus tendinopathy (Sn 96.6%; Sp 93.3%), biceps tenosynovitis (Sn 87.5%; Sp 97.6%), subacromial-subdeltoid bursitis (Sn 72.7%; Sp 95.7%), humeral erosions (Sn 90.5%; Sp 97.3%), and acromioclavicular osteoarthritis (Sn 85.7%; Sp 95.7%). In terms of reliability, the agreement between US and MRI was almost perfect (κ = .9, P < .001). CONCLUSION US may have a role as the initial imaging modality in RA patients with shoulder pain, as it is highly sensitive and specific in detecting different pathological abnormalities of the shoulder.
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Affiliation(s)
- Mohamed Gamal Abdelzaher
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Samar Tharwat
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed AbdElkhalek
- Radiodiagnosis Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Abdelsalam
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Odom MJ, Grace KA, Brigido MK, Theyyunni NR, Kessler RA, Greineder CF. Shoulder Pseudodislocation Associated with Calcific Tendinitis/Bursitis and Diagnosed by Point of Care Ultrasound. J Emerg Med 2019; 58:72-76. [PMID: 31677978 PMCID: PMC7190407 DOI: 10.1016/j.jemermed.2019.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/25/2019] [Accepted: 08/28/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Shoulder pseudodislocation, or "drooping shoulder," presents with acute pain and deformity of the joint, with radiographs demonstrating inferior subluxation of the humeral head relative to the glenoid fossa. The diagnosis must be made promptly and distinguished from true glenohumeral dislocation, both to avoid unnecessary attempts at closed reduction and to facilitate investigation of the underlying cause, which may include septic arthritis, hemarthrosis, or other emergent etiologies. Point-of-care ultrasound (POCUS) may be useful in the evaluation of emergency department (ED) patients with suspected pseudodislocation. CASE REPORT A 50-year old female presented to the ED with an acutely painful and deformed shoulder but atypical history and physical examination. Initial radiography appeared to show a glenohumeral dislocation, but POCUS, done to guide intra-articular lidocaine injection, led to recognition of pseudodislocation and subsequent diagnosis of calcific tendinitis/bursitis, a condition not previously associated with inferior humeral subluxation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Shoulder pseudodislocation must be considered in the evaluation of patients with suspected glenohumeral dislocation, but atypical features on history, physical examination, or initial plain radiography. POCUS may facilitate prompt diagnosis and identification of the underlying etiology.
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Affiliation(s)
- Mitchell J Odom
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kelsey A Grace
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Nikhil R Theyyunni
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ross A Kessler
- Department of Emergency Medicine, University of Washington, Seattle, Washington
| | - Colin F Greineder
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; Department of Pharmacology, University of Michigan, Ann Arbor, Michigan
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McLoughlin E, Murphy J, Iqbal A, McGarry S, James SL, Botchu R. The effect of operator experience on scanning time in ultrasound assessment of the shoulder. SONOGRAPHY 2019. [DOI: 10.1002/sono.12192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Emer McLoughlin
- Department of Musculoskeletal RadiologyRoyal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Jennifer Murphy
- Department of Musculoskeletal RadiologyRoyal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Aamer Iqbal
- Department of Musculoskeletal RadiologyRoyal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Sharon McGarry
- Department of Musculoskeletal RadiologyRoyal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Steven L. James
- Department of Musculoskeletal RadiologyRoyal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Rajesh Botchu
- Department of Musculoskeletal RadiologyRoyal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
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Kuo YC, Hsieh LF. Validity of Cyriax’s Functional Examination for Diagnosing Shoulder Pain: A Diagnostic Accuracy Study. J Manipulative Physiol Ther 2019; 42:407-415. [DOI: 10.1016/j.jmpt.2018.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 11/19/2018] [Accepted: 11/27/2018] [Indexed: 11/25/2022]
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Mohtasib RS, Alzahrani AM, Asiri YN, Rayes ZF, Alshaalan MA. Accuracy of shoulder ultrasound examination for diagnosis of rotator cuff pathologies: a single-center retrospective study. Ann Saudi Med 2019; 39:162-171. [PMID: 31215221 PMCID: PMC6832332 DOI: 10.5144/0256-4947.2019.162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Shoulder pathologies need accurate diagnosis for best management and treatment provided to patients. OBJECTIVE Determine the diagnostic sensitivity, specificity and accuracy of shoulder ultrasonography (US). DESIGN Retrospective, analytical. SETTING Tertiary care center in Riyadh, Saudi Arabia. PATIENTS AND METHODS We included all shoulder exams performed between January 2010 and December 2016 that met the inclusion criteria. Data was collected retrospectively from the a picture archiving and communication system and patient records. The patients were evaluated using US for the presence of rotator cuff tears and classified into intact, full-thickness tear, partial-thickness tear, tendinosis, subacromial/subdeltoid bursitis and acromioclavicular joint degenerative changes. The US findings were correlated with the shoulder MRI study findings. The time interval between the US examination and MRI ranged from 0 to 180 days (6 months). MAIN OUTCOME MEASURES To compare the sensitivity, specificity and accuracy of shoulder US studies in the detection of rotator cuff pathologies in comparison to MRI findings. SAMPLE SIZE AND CHARACTERISTICS 86 (60 females, 26 male), mean age 53.7 years (range, 19-85). RESULTS The sensitivity, specificity and accuracy of US for the detection of full-thickness supraspinatus tears compared with those of MRI were 86%, 82% and 83%, respectively. The sensitivity, specificity and accuracy of US for the detection of partial-thickness supraspinatus tears compared with those of MRI were 38%, 70% and 58%, respectively. Overall PPV, NPV, sensitivity, specificity and accuracy of US for the detection of full-thickness tears compared with those of MRI were 35%, 97%, 78%, 83% and 83%, respectively. For partial-thickness tears, the overall PPV, NPV, sensitivity, specificity and accuracy of US compared with those of MRI were 51%, 60%, 51%, 60% and 56%, respectively. CONCLUSION Overall, US has high sensitivity, specificity and accuracy for the detection of full-thickness tears compared with the detection of partial-thickness tears. LIMITATIONS Small sample size and retrospective. CONFLICT OF INTEREST None.
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Affiliation(s)
- Rafat Saeed Mohtasib
- From the Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abeer Mohd Alzahrani
- From the Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Yasser Nasser Asiri
- From the Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ziad Fahad Rayes
- From the Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Meshal Abdulaziz Alshaalan
- From the Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Chin K, Chowdhury A, Leivadiotou D, Marmery H, Ahrens PM. The accuracy of plain radiographs in diagnosing degenerate rotator cuff disease. Shoulder Elbow 2019; 11:46-51. [PMID: 31019562 PMCID: PMC6463379 DOI: 10.1177/1758573217743942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/25/2017] [Accepted: 10/17/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND A number of radiographic signs have been previously demonstrated to be associated with degenerative rotator cuff tears. An ability to predict the presence of a tear by radiography would permit the early commencement of appropriate treatment and the avoidance of unnecessary invasive investigations. The aim of the present study was to determine the accuracy of using radiographic signs to predict the presence of a cuff tear on arthroscopy. METHODS Fifty consecutive patients who had undergone shoulder arthroscopy and had pre-operative plain radiographs were included. Pre-operative radiographs were reviewed by a consultant shoulder surgeon, a consultant radiologist and a senior clinical fellow for the following signs: acromial spur; subjective reduction of subacromial space; sourcil sign; acromial acetabularization; os acromiale; greater tuberosity cortical irregularity; greater tuberosity sclerosis; humeral head rounding; cyst; and reduction in acromiohumeral head distance. RESULTS The presence of tuberosity sclerosis (p < 0.0001), tuberosity irregularities (p < 0.0001), tuberosity cyst (p = 0.004) and sourcil sign (p = 0.019) was associated with the presence of a rotator cuff tear. The combined sensitivity of prediction of tear by the observers following radiographic review was 91.7%, with a combined negative predictive value of 80%. CONCLUSIONS The assessment of radiographs by senior clinicians is a useful tool for confirming the absence of a rotator cuff tear.
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Affiliation(s)
- Kuen Chin
- Kuen Chin, Ponders Street, Royal Free London
NHS Foundation Trust, London NW3 2QG, UK.
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41
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Chang RF, Lee CC, Lo CM. Quantitative diagnosis of rotator cuff tears based on sonographic pattern recognition. PLoS One 2019; 14:e0212741. [PMID: 30817804 PMCID: PMC6394937 DOI: 10.1371/journal.pone.0212741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 02/08/2019] [Indexed: 11/30/2022] Open
Abstract
The lifetime prevalence of shoulder pain is nearly 70% and is mostly attributable to subacromial disorders. A rotator cuff tear is the most severe form of subacromial disorders, and most occur in the supraspinatus. For clinical examination, shoulder ultrasound is recommended to detect supraspinatus tears. In this study, a computer-aided tear classification (CTC) system was developed to identify supraspinatus tears in ultrasound examinations and reduce inter-operator variability. The observed cases included 89 ultrasound images of supraspinatus tendinopathy and 102 of supraspinatus tear from 136 patients. For each case, intensity and texture features were extracted from the entire lesion and combined in a binary logistic regression classifier for lesion classification. The proposed CTC system achieved an accuracy rate of 92% (176/191) and an area under receiver operating characteristic curve (Az) of 0.9694. Based on its diagnostic performance, the CTC system has promise for clinical use.
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Affiliation(s)
- Ruey-Feng Chang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Chung-Chien Lee
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Department of Orthopedic Surgery, New Taipei City Hospital, New Taipei City, Taiwan
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail: ;
| | - Chung-Ming Lo
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Library, Information and Archival Studies, National Chengchi University, Taipei, Taiwan
- * E-mail: ;
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42
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Micallef J, Pandya J, Low AK. Management of rotator cuff tears in the elderly population. Maturitas 2019; 123:9-14. [PMID: 31027684 DOI: 10.1016/j.maturitas.2019.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 12/23/2022]
Abstract
Rotator cuff tears (RCTs) are a common cause of shoulder pain and weakness in the elderly (age > 65yrs) and result in reduced quality of life, loss of income and a burden on health care. With the elderly population living longer there is a growing interest in the effective and efficient management of RCTs. In a majority of cases, the initial treatment is conservative, with physical therapy, analgesics and possibly corticosteroid or plasma rich protein injections. There are various surgical options, including rotator cuff repair, superior capsule reconstruction, subacromial decompression and reverse shoulder arthroplasty. The aim of this article is to provide a narrative review of evidence guiding the management options for RCTs in the elderly.
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Affiliation(s)
| | - Jay Pandya
- Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
| | - Adrian K Low
- University of Sydney, Sydney Adventist Hospital, Clinical School, Department of Orthopaedic Surgery, Sydney, NSW, Australia.
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43
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Okoroha KR, Fidai MS, Tramer JS, Davis KD, Kolowich PA. Diagnostic accuracy of ultrasound for rotator cuff tears. Ultrasonography 2018; 38:215-220. [PMID: 30744304 PMCID: PMC6595130 DOI: 10.14366/usg.18058] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/17/2018] [Indexed: 12/21/2022] Open
Abstract
Ultrasonography (US) is an inexpensive, convenient, and effective tool that can be used to evaluate the shoulder. It does not expose the patient to harmful radiation and can be used to evaluate the musculoskeletal system dynamically. Additionally, US is not subject to metal artifacts when evaluating patients with previously placed hardware. Over the years, US has been found to be reliable and accurate for diagnosing rotator cuff tears (RCTs), despite its operator-dependence. The usage of US for diagnosing RCTs in orthopedic practice varies depending on practitioners’ familiarity with the exam and the availability of experienced technicians. The purpose of this article is to review the diagnostic accuracy of US for identifying RCTs.
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Affiliation(s)
- Kelechi R Okoroha
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Mohsin S Fidai
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Joseph S Tramer
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA
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Jancuska J, Matthews J, Miller T, Kluczynski MA, Bisson LJ. A Systematic Summary of Systematic Reviews on the Topic of the Rotator Cuff. Orthop J Sports Med 2018; 6:2325967118797891. [PMID: 30320144 PMCID: PMC6154263 DOI: 10.1177/2325967118797891] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The number of systematic reviews and meta-analyses published on the rotator cuff (RC) has increased markedly. PURPOSE To quantify the number of systematic reviews and meta-analyses published on the RC and to provide a qualitative summary of the literature. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic search for all systematic reviews and meta-analyses pertaining to the RC published between January 2007 and September 2017 was performed with PubMed, MEDLINE, and the Cochrane Database of Systematic Reviews. Narrative reviews and non-English language articles were excluded. RESULTS A total of 1078 articles were found, of which 196 met the inclusion criteria. Included articles were summarized and divided into 15 topics: anatomy and function, histology and genetics, diagnosis, epidemiology, athletes, nonoperative versus operative treatment, surgical repair methods, concomitant conditions and surgical procedures, RC tears after total shoulder arthroplasty, biological augmentation, postoperative rehabilitation, outcomes and complications, patient-reported outcome measures, cost-effectiveness of RC repair, and quality of randomized controlled trials. CONCLUSION A qualitative summary of the systematic reviews and meta-analyses published on the RC can provide surgeons with a single source of the most current literature.
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Affiliation(s)
- Jeffrey Jancuska
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - John Matthews
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - Tyler Miller
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - Melissa A. Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - Leslie J. Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
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45
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Teng A, Liu F, Zhou D, He T, Chevalier Y, Klar RM. Effectiveness of 3-dimensional shoulder ultrasound in the diagnosis of rotator cuff tears: A meta-analysis. Medicine (Baltimore) 2018; 97:e12405. [PMID: 30213014 PMCID: PMC6156036 DOI: 10.1097/md.0000000000012405] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/24/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Numerous quantitatively based studies measuring the accuracy of 3D shoulder ultrasound (US) for the diagnosis of rotator cuff tears remain inconclusive. In order to determine how effective 3D shoulder US is for detecting rotator cuff tears, a meta-analysis was performed systematically. METHODS Six electronic databases, PubMed/Medline, Embase, Cochrane Library, CNKI, VIP data, and Wanfang data, were utilized to retrieve articles praising the diagnostic value of 3D shoulder US for use in detecting rotator cuff tears. After screening and diluting out the articles that met inclusion criteria to be used for statistical analysis, the pooled evaluation indexes including sensitivity, specificity, and diagnostic odds ratio (DOR) as well as the summary receiver operating characteristic curve (SROC) were calculated utilizing Meta-Disc v.1.4. RESULTS Screening determined that out of 4220, 7 studies involving a total of 282 patients were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that the sensitivity and specificity were at 94% and 83%, respectively, with a DOR of 60.06, Q* index of 0.9058 and the area under SROC of 0.9609. Additionally, a satisfactory accuracy of 3D shoulder US was observed in detecting full- and partial-thickness rotator cuff tears. CONCLUSION This meta-analysis suggests that 3D shoulder US is very effective and highly accurate to detect full-thickness rotator cuff tears, but may lack accuracy in the diagnosis of partial tears.
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Affiliation(s)
- Aiping Teng
- Department of Ultrasonography, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Fanxiao Liu
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Dongsheng Zhou
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Tao He
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Yan Chevalier
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Roland M. Klar
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
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Abstract
The use of point-of-care ultrasound in trauma is widespread. Focused Assessment with Sonography for Trauma examination is a prototypical bedside examination used by the treating provider to quickly determine need for intervention and appropriate patient disposition. The role of bedside ultrasound in trauma, however, has expanded beyond the Focused Assessment with Sonography for Trauma examination. Advancements in diagnostics include contrast-enhanced ultrasound, thoracic, and musculoskeletal applications. Ultrasound is also an important tool for trauma providers for procedural guidance including vascular access and regional anesthesia. Its portability, affordability, and versatility have made ultrasound an invaluable tool in trauma management in resource-limited settings. In this review, we discuss these applications and the supporting evidence for point-of-care ultrasound in trauma.
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Affiliation(s)
- Timothy Gleeson
- Department of Emergency Medicine, University of Massachusetts, University of Massachusetts Medical School, Worcester, MA.
| | - David Blehar
- Department of Emergency Medicine, University of Massachusetts, University of Massachusetts Medical School, Worcester, MA
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47
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Abstract
Ultrasonography is an imaging modality that facilitates the diagnosis of pathology and injection therapy without exposing the patient to radiation. In addition, ultrasonography has become popular because of its portability, low cost, and production of real-time tomographic images that provide a cross-sectional view of anatomic structures. Despite its benefits and widespread adoption in general medicine and other specialties, however, ultrasonography is not as well adapted as a diagnostic and research tool in orthopaedic surgery. An understanding of the basic principles of ultrasonography and the evidence supporting its use can aid the orthopaedic surgeon in applying this modality appropriately in clinical practice.
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48
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Kim HJ, Park JS, Kim JY, Kee YM, Rhee YG. Interstitial tears of the rotator cuff: difficulty in preoperative diagnosis. J Shoulder Elbow Surg 2018; 27:487-492. [PMID: 29122450 DOI: 10.1016/j.jse.2017.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/01/2017] [Accepted: 09/09/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have investigated the characteristic findings of preoperative magnetic resonance imaging (MRI) and the clinical and radiologic outcomes of interstitial tear of the rotator cuff treated with arthroscopic repair after tear completion. METHODS Forty-one patients (14 men and 27 women; mean age, 56.5 years) with arthroscopically confirmed interstitial tears underwent single-row repair after tear completion. The minimum follow-up period was 2 years. RESULTS Twenty-eight patients (68.3%) were properly evaluated with MRI before surgery. Seven cases (17.1%) were misdiagnosed as bursal-sided tears and 5 cases (12.2%) were misdiagnosed as articular-sided tears on the basis of presurgical MRI findings. Arthroscopy revealed fibrillation and dimpling of the tendon surface in all cases and congestion within the defect in 36 cases (87.8%). At the final follow-up, the visual analog scale score for pain during motion decreased to 0.8 from a preoperative mean of 6.1 (P <.001). Moreover, at the final follow-up, the mean University of California-Los Angeles score and Constant score improved from 15.7 and 51.8 to 32.1 and 83.8, respectively (P <.001 for all). At 9 months after surgery, MRI revealed no cases of retear. CONCLUSION Interstitial tears are difficult to diagnose before surgery because MRI findings may lead to the misdiagnosis of interstitial tears as articular- or bursal-sided tears. If MRI-based diagnosis is indicative of articular- or bursal-sided tears but arthroscopy reveals fibrillation and dimpling of the tendon surface, interstitial tears should be suspected. The defective sites in interstitial tears are usually accompanied by congestion.
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Affiliation(s)
- Hwan Jin Kim
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ji Seon Park
- Department of Radiology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Youn Kim
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Young Moon Kee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Strudwick K, McPhee M, Bell A, Martin-Khan M, Russell T. Review article: Best practice management of common shoulder injuries and conditions in the emergency department (part 4 of the musculoskeletal injuries rapid review series). Emerg Med Australas 2018; 30:456-485. [PMID: 29345427 DOI: 10.1111/1742-6723.12921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/24/2017] [Accepted: 11/23/2017] [Indexed: 01/16/2023]
Abstract
Shoulder injuries are a commonly presenting complaint to the ED. In the absence of an obvious deformity, they can be difficult to assess and definitively diagnose because of the multiple structures that cause shoulder pain, the acuity and severity of pain and the lack of range of motion in the ED setting. The quality of ED care provided to patients with musculoskeletal shoulder pain is crucial to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common shoulder injuries and conditions in the ED. Databases were searched in 2017, including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites. Primary studies, systematic reviews and guidelines published in English-language in the past 12 years that addressed the acute assessment, management, follow-up plan or prognosis were considered for inclusion. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence. The search revealed 1902 articles, of which 73 were included in the review (n = 12 primary articles, n = 49 systematic reviews and n = 12 guidelines). This rapid review provides clinicians who manage shoulder dislocations, fractures and soft tissue injuries in the ED a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. There is strong evidence to support taking a thorough history and physical examination, with cautious use of special tests because of their poor diagnostic accuracy. Key points regarding the diagnosis and management of these injuries are provided.
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Affiliation(s)
- Kirsten Strudwick
- Emergency Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Megan McPhee
- Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Anthony Bell
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Artul S, Habib G. Ultrasonographic clues for acuity/chronicity of rotator cuff tear. Eur J Rheumatol 2017; 4:260-263. [PMID: 29308280 PMCID: PMC5741338 DOI: 10.5152/eurjrheum.2017.17047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/25/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To look prospectively for ultrasonographic clues for acuity/chronicity of rotator cuff tear (RCT) among patients with shoulder pain. MATERIAL AND METHODS Patients with shoulder pain who were referred for musculoskeletal ultrasonography and diagnosed with RCT were asked to participate in our study. After consent, demographic, clinical, laboratory, and ultrasonographic findings, including age, gender, history of trauma, type of tendon with tear, tendon tear size, tendon effusion, bursal effusion, calcification, tendon thickness, and duration of shoulder pain were documented. Shoulder pain duration of ≤2 months was considered as an acute case. Patients were divided into group 1 (with acute shoulder pain) and group 2 (patients with chronic shoulder pain; pain duration of >2 months), and the various parameters of the two groups were compared to look for significant differences between the two groups. Student's unpaired t-test and the chi-square test were used for continuous and categorical parameters, respectively. RESULTS A total of 112 patients were diagnosed with RCT, and 132 tears were documented. Sixty-three patients (~56%) were male, and the mean age of all the patients was 54.2±15.2 years. A total of 44% of the patients belonged to group 1 (with acute pain). The existence of either a subdeltoid bursal effusion (SBE) or a biceps peritendon effusion (BPE) and thick tendon were observed significantly more among patients in group 1 compared to patients in group 2. CONCLUSION The existence of either an SBE or a BPE and thick tendon were signs of an acute RCT.
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Affiliation(s)
- Suheil Artul
- Department of Radiology, Nazareth Hospital, Faculty of Medicien, Gallile School of Mediciene, Bar-Ilan University, Ramat Gan, Israel
| | - George Habib
- Rheumatology Unit, Laniado Medical Center, Netanya, School of Medicine, Technion, Israel Institute of Technology Haifa, and Rheumatology Clinic, Nazareth Hospital, Nazareth, Israel
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