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Radhakrishnan R, Goh J, Tan AHC. Partial-thickness rotator cuff tears: a review of current literature on evaluation and management. Clin Shoulder Elb 2024; 27:79-87. [PMID: 37559523 PMCID: PMC10938024 DOI: 10.5397/cise.2022.01417] [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: 12/11/2022] [Revised: 02/12/2023] [Accepted: 03/12/2023] [Indexed: 08/11/2023] Open
Abstract
Rotator cuff disease is a common cause of shoulder pain for which partial-thickness rotator cuff tears occupy a significant proportion. Such tears are often difficult to diagnose and manage in the general clinic setting. A review of the available literature from well-known databases was performed in this study to provide a concise overview of partial-thickness rotator cuff tears to aid physicians in their understanding and management.
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Affiliation(s)
| | - Joshua Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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2
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Yel I. [Lesions of the rotator cuff and biceps tendon]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:110-118. [PMID: 38231415 DOI: 10.1007/s00117-023-01251-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/18/2024]
Abstract
CLINICAL/METHODOLOGICAL PROBLEM The rotator cuff is a complex anatomical structure and the integrity is pivotal for the shoulder functionality. The pathologies are often multifactorial, resulting from degenerative, vascular, traumatic and mechanical factors. RADIOLOGICAL STANDARD PROCEDURES Radiography, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) form the pillars of radiological diagnostics. Each modality has specific advantages and limitations in the visualization and assessment of pathologies of the rotator cuff and biceps tendon. METHODOLOGICAL INNOVATIONS The MR arthrography offers additional insights in unclear cases by enhancing the differentiation between complete and partial tears. PERFORMANCE The MRI provides detailed information on tendon quality and associated damages, such as muscle atrophy and fat infiltration, making it the preferred method. The use of MR arthrography can identify defects through increased intra-articular pressure or contrast medium leakage. EVALUATION Muscle damage, as induced by edema in acute injuries or fatty degeneration in chronic conditions, can be evaluated using imaging techniques. Special attention is warranted for the infraspinatus, subscapularis and teres minor muscles due to their unique injury patterns and prevalences.
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Affiliation(s)
- I Yel
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland.
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3
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Mann MR, Plutecki D, Janda P, Pękala J, Malinowski K, Walocha J, Ghosh SK, Balawender K, Pękala P. The subscapularis muscle: A meta-analysis of its variations, prevalence, and anatomy. Clin Anat 2023; 36:527-541. [PMID: 36597929 DOI: 10.1002/ca.24008] [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: 09/29/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND The subscapularis (SSC) is the largest rotator cuff muscle and is involved in the medial rotation, abduction, adduction, and anterior stabilization of the shoulder. It is anatomically variable, as is the morphology and prevalence of the accessory SSC (aSSC), a rare muscle slip attached to the SSC. There is no current review investigating the prevalence and morphometrics of the SSC and aSSC. PURPOSE To investigate the prevalence of the morphological variants of the SSC and aSSC via meta-analysis and review the relevant literature involving cadaveric, magnetic resonance imaging, and ultrasonographic studies. STUDY DESIGN Meta-analysis. MATERIALS AND METHODS Literature data reporting the prevalence rates and morphometrics of the SSC and aSSC and their variants were pooled. Literature searches and data analyses were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Anatomical Quality Assurance guidelines. RESULTS Forty-six studies, totaling 2166 shoulders, were assessed. The SSC showed an overall length, thickness, cross-sectional area, and volume of 152.2 mm (95% confidence interval, CI, 103.8-200.5 mm), 5.6 mm (95% CI, 4.6-6.6 mm), 18.1 cm2 (95% CI, 14.2-22.0 cm2 ), and 126.9 cm3 (95% CI, 87.2-166.5 cm3 ), respectively. The SSC displayed substantial variations in its origin and insertion points and in the composition of its tendon. The aSSC had an overall pooled prevalence of 24.6% (95% CI, 0.0%-76.9%). CONCLUSIONS The SSC and aSSC have been implicated in multiple shoulder pathologies, including muscle and tendon ruptures and neurovascular compromise. A better understanding of SSC and aSSC variants when diagnosing and treating their related pathologies will reduce patient morbidity and improve treatment regimens.
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Affiliation(s)
- Mitchell R Mann
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Dawid Plutecki
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Patryk Janda
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Konrad Malinowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Sanjib Kumar Ghosh
- Department of Anatomy, All India Institute of Medical Sciences, Patna, India
| | - Krzysztof Balawender
- Department of Morphological Sciences, College of Medical Sciences, Institute of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Przemysław Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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4
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Manske R, Podoll K, Markowski A, Watkins M, Hayward L, Maitland M. Physical Therapists Use of Diagnostic Ultrasound Imaging in Clinical Practice: A Review of Case Reports. Int J Sports Phys Ther 2023; 18:215-227. [PMID: 36793560 PMCID: PMC9897039 DOI: 10.26603/001c.68137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/26/2022] [Indexed: 02/04/2023] Open
Abstract
Objective Ultrasound diagnostic imaging (USI) is widely utilized in sports medicine, orthopaedics, and rehabilitation. Its use in physical therapy clinical practice is increasing. This review summarizes published patient case reports describing USI in physical therapist practice. Design Comprehensive literature review. Literature Search PubMed was searched using the keywords "physical therapy" AND "ultrasound" AND "case report" AND "imaging". In addition, citation indexes and specific journals were searched. Study Selection Criteria Papers were included if the patient was attending physical therapy, USI was necessary for patient management, the full text was retrievable, and the paper was written in English. Papers were excluded if USI was only used for interventions, such as biofeedback, or if the USI was incidental to physical therapy patient/client management. Data Synthesis Categories of data extracted included: 1) Patient presentation; 2) Setting; 3) Clinical indications; 4) Who performed USI; 5) Anatomical region; 6) Methods of USI; 7) Additional imaging; 8) Final diagnosis; and 9) Case outcome. Results Of the 172 papers reviewed for inclusion, 42 were evaluated. Most common anatomical regions scanned were the foot and lower leg (23%), thigh and knee (19%), shoulder and shoulder girdle (16%), lumbopelvic region (14%), and elbow/wrist and hand (12%). Fifty-eight percent of the cases were deemed static, while 14% reported using dynamic imaging. The most common indication for USI was a differential diagnosis list that included serious pathologies. Case studies often had more than one indication. Thirty-three cases (77%) resulted in confirmation of a diagnosis, while 29 case reports (67%) documented significant changes in physical therapy intervention strategies due to the USI, and 25 case reports (63%) resulted in referral. Conclusion This review of cases provides details on unique ways USI can be used during physical therapy patient care, including aspects that reflect the unique professional framework.
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Affiliation(s)
| | | | | | | | | | - Murray Maitland
- Department of Rehabilitation Medicine University of Washington
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Page P, Manske RC, Voight M, Wolfe C. MSK Ultrasound - An IJSPT Perspective. Int J Sports Phys Ther 2023; 18:1-10. [PMID: 36793557 PMCID: PMC9897034 DOI: 10.26603/001c.68184] [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] [Indexed: 02/04/2023] Open
Abstract
MSK ultrasound is a valuable imaging technique which has become increasingly popular in recent years. This efficient technique proves beneficial in a variety of ways. MSK ultrasound effectively streamlines the process by enabling practitioners to securely and accurately image and assess structures all in one simple step. By allowing healthcare providers to access critical information quickly and conveniently, MSK ultrasound can help identify conditions early when interventions are most effective. Moreover, it may be able to shorten diagnostic times and reduce costs through more cost-effective use of resources such as imaging and laboratory testing. Furthermore, MSK ultrasound can provide additional insights into musculoskeletal anatomy and help improve patient care and outcomes. In addition, utilizing this method reduces exposure to radiation and provides enhanced patient comfort with its quick scan duration. MSK ultrasound has a high potential to provide quick and accurate diagnosis of MSK disturbances when used correctly. As clinicians become more comfortable and familiar with this technology, we will continue to see its use expand for various MSK assessments. In this commentary we'll explore how ultrasound can be used in physical therapy, specifically for musculoskeletal assessment. We'll also look at some of the potential benefits and limitations of using ultrasound in PT practice.
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Affiliation(s)
- Phil Page
- Doctor of Physical Therapy Program Franciscan University
| | | | | | - Chris Wolfe
- School of Physical Therapy Belmont University
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Singh K, Hosseini N, Pooyan A, Zadeh FS, Chalian M. Imaging Tendon Disorders in Athletes. Clin Podiatr Med Surg 2023; 40:223-238. [PMID: 36368845 DOI: 10.1016/j.cpm.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Imaging plays a critical role in evaluating pathology affecting athletes from various fields. Tendon pathology manifests in terms of mechanical, degenerative, enthesitis, neoplastic, and overuse diseases. Tendon pathologies in athletes usually involve injuries to commonly injured tendons such as the tendons involving the ankle, elbow, rotator cuff, hip abductors, patellar tendon, and Achilles tendon. For the purposes of this article, the focus will be on the tendons involving the ankle such as the tibialis posterior and peroneal tendons. The 2 most common imaging modalities used for the evaluation of tendons are ultrasound (US) and magnetic resonance imaging (MRI). There are several emerging imaging techniques such as T2 mapping, ultra-short echo time MRI, and sonoelastography. These novel imaging techniques are all in research phase and have not been adapted to routine clinical practice.
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Affiliation(s)
- Kanwardeep Singh
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA
| | - Nastaran Hosseini
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA. https://twitter.com/Nas_Hosseini
| | - Atefe Pooyan
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA. https://twitter.com/AtefePooyan
| | - Firoozeh Shomal Zadeh
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA. https://twitter.com/FiroozehShomal
| | - Majid Chalian
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA.
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Agarwal A, Vani K, Batta A, Verma K, Chumber S. Can ultrasound suffice for triaging patients requiring surgical correction of rotator cuff tears—a comparative evaluation of ultrasound and magnetic resonance imaging. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Objectives: To comparatively evaluate the role of ultrasound and MRI in rotator cuff and biceps tendon pathologies and to establish ultrasound as a consistently reproducible, quick and accurate primary investigation modality sufficient to triage patients requiring surgical correction of full thickness rotator cuff tears. Methods: Fifty patients, clinically suspected to have rotator cuff and/or biceps tendon pathologies, with no contraindications to MRI, were evaluated by US and MRI, in a prospective cross-sectional observational study. US was done with high-frequency linear probe, and MRI was done on a 1.5-T scanner using T1 oblique sagittal, proton density (PD)/T2 fat-suppressed (FS) oblique sagittal, T1 axial, PD/T2 FS axial, T1 oblique coronal, T2 oblique coronal and PD FS oblique coronal sequences. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. The sensitivity, specificity, PPV, NPV and accuracy were also calculated to analyze the diagnostic accuracy of US findings correlating with MRI findings. A p value less than 0.05 was taken to indicate a significant difference.
Results
Mean age was 45 years; 74% patients were males; 77% females and 60% males had tears. Majority of patients with rotator cuff tears were in the sixth decade of life. The frequency of tears was higher among older patients. Fourteen percent of patients had full thickness tears while 64% had partial thickness tears. US was comparable to MRI for detection of full thickness tears with overall sensitivity, specificity, PPV and accuracy of 93.8%, 100%, 100% and 98.2%, respectively (p value < 0.001). For partial thickness tears, US had overall sensitivity, specificity, PPV and accuracy of 75.6%, 82.6%, 89.5% and 78%, respectively (p value < 0.001), as compared to MRI. Subacromial-subdeltoid bursal effusion and long head of biceps tendon sheath effusion were common associated, though, non-specific findings.
Conclusion
Ultrasound findings in our study were found to be in significant correlation with findings on MRI in detection of rotator cuff tears. US was equivalent to MRI in detection of full thickness tears and fairly accurate for partial thickness tears. Therefore, US should be considered as the first line of investigation for rotator cuff pathologies.
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Korkmaz N, Gurcay E, Demir Y, Tezen Ö, Korkmaz İ, Atar MÖ, Yaşar E. The effectiveness of high-intensity laser therapy in the treatment of post-stroke patients with hemiplegic shoulder pain: a prospective randomized controlled study. Lasers Med Sci 2021; 37:645-653. [PMID: 33829317 DOI: 10.1007/s10103-021-03316-y] [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: 12/16/2020] [Accepted: 04/02/2021] [Indexed: 11/29/2022]
Abstract
To evaluate clinical and ultrasonographic efficacy of high-intensity laser therapy (HILT) in patients with hemiplegic shoulder pain (HSP) accompanied by partial thickness rotator cuff tear (PTRCT). The study was designed as a prospective, randomized, controlled trial. Patients with HSP accompanied by PTRCT (n = 44) were randomly assigned to HILT and control groups. Both groups were treated with a multidisciplinary stroke rehabilitation and a therapeutic exercise program to the affected shoulder supervised by physiotherapists. In addition, HILT group received 3 sessions of the intervention per week for 3 weeks. Primary outcome measure was visual analogue scale (VAS) for pain. Secondary outcome measures were range of motion (ROM) of the shoulder joint, Shoulder Pain and Disability Index (SPADI), Brunnstrom Recovery Stage (BRS), Modified Ashworth Scale (MAS), Nottingham Health Profile (NHP), Functional Independence Measure (FIM), and ultrasonographic PTRCT size. Participants were assessed at pre- and post-treatment. A total of 41 patients completed the study. A statistically significant improvement was observed in VAS, ROM, FIM, SPADI, NHP, and PTRCT parameters in HILT group at post-treatment compared to pre-treatment (all P < 0.05). However, control group indicated significant improvement only in VAS, ROM, and SPADI parameters (all P < 0.05). When differences in clinical parameters at pre- and post-treatment assessment were compared between two groups, change in VAS, FIM, BRS, SPADI, NHP, and PTRCT in HILT group was significantly better than control group (all P < 0.05). HILT combined with therapeutic exercise seems to be clinically and ultrasonographically more effective in the treatment of patients with HSP accompanied by PTRCT than therapeutic exercise alone in the short term. Further studies are needed with long-term follow-up. CinicalTrials.gov Identifier: NCT04669405.
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Affiliation(s)
- Nurdan Korkmaz
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey.
| | - Eda Gurcay
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Yasin Demir
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Özge Tezen
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - İzzet Korkmaz
- Department of Orthopaedic Surgery, Ankara City Hospital, Ankara, Turkey
| | - Merve Örücü Atar
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Evren Yaşar
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
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Laucis NC, Rosen KA, Thodge A, Leschied JR, Klochko CL, Soliman SB. Sonographic evaluation of the association between calcific tendinopathy and rotator cuff tear: a case-controlled comparison. Clin Rheumatol 2021; 40:2897-2905. [PMID: 33479863 DOI: 10.1007/s10067-021-05597-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To compare the incidence of rotator cuff (RC) tears on shoulder ultrasounds of patients with RC calcific tendinopathy (CaT) to that of a control group without CaT. METHOD In this retrospective case-control study, 50 shoulder ultrasounds of patients with CaT were compared independently by 2 musculoskeletal radiologists to 50 patients from a control group without CaT to catalog the number and type of RC tears. RC tears in the CaT group were further characterized based on location, into tears in the specific tendon(s) containing calcium versus all tendon tears. RESULTS RC tears were diagnosed in 38% (19/50) of the control group (16 full-thickness) as compared to 22% (11/50) with CaT (6 full-thickness). The fewer full-thickness tears in the CaT group (12%, 6 of 50) compared to that in the control group (32%, 16 of 50) was statistically significant (P = 0.016, odds ratio 0.29). Only 7 of the 11 tears in the CaT group were in a calcium-containing tendon (3 full-thickness). The fewer calcium-containing tendon tears compared to tears in the control group was also statistically significant (P = 0.006, odds ratio 0.27). Furthermore, the fewer full-thickness calcium-containing tendon tears (6%, 3/50) compared to full-thickness tears in the control group (32%, 16/50) were yet more statistically significant (P = 0.001, odds ratio 0.14). CONCLUSIONS In patients with shoulder pain and CaT, we observed a decreased number of RC tears and especially calcium-containing tendon tears, as compared to similar demographic patients with shoulder pain but without CaT. Key Points • Patients with rotator cuff calcific tendinopathy have few rotator cuff tears, especially full-thickness tears, compared to a control group without calcific tendinopathy. • The tendons containing the calcium hydroxyapatite deposition were the least likely to have a rotator cuff tear. • Future studies could evaluate if calcium hydroxyapatite deposition provides a protective mechanism against rotator cuff tears. • Musculoskeletal ultrasound is more sensitive than MRI in the evaluation of rotator cuff calcific tendinopathy.
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Affiliation(s)
- Nicholas C Laucis
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Kelli A Rosen
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Anay Thodge
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Jessica R Leschied
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Chad L Klochko
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Steven B Soliman
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA.
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10
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Abstract
Imaging evaluation of the shoulder is performed using multiple modalities, including ultrasound (US) and MR imaging. Clinicians often wonder which modality to use to work up their patients with shoulder pain. Although MR imaging has remained the workhorse of shoulder imaging, US has increased in popularity among academic and private institutions. Both modalities offer similar diagnostic information in regards to rotator cuff pathology and other soft tissues, although they differ in their technique, indications, and interpretation. A thorough understanding of these differences is imperative to appropriately use these modalities in clinical practice, including the unique interventional opportunities available with US.
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Affiliation(s)
- David C Gimarc
- Department of Radiology, University of Colorado School of Medicine, 12401 E. 17th Avenue, Mail Stop L954, Aurora, CO 80045, USA.
| | - Kenneth S Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/342, Madison, WI 53792, USA
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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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12
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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
| | - 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
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13
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Baloch N, Hasan OH, Jessar MM, Hattori S, Yamada S. “Sports Ultrasound”, advantages, indications and limitations in upper and lower limbs musculoskeletal disorders. Review article. Int J Surg 2018; 54:333-340. [DOI: 10.1016/j.ijsu.2017.11.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 11/26/2022]
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Liu JN, Garcia GH, Gowd AK, Cabarcas BC, Charles MD, Romeo AA, Verma NN. Treatment of Partial Thickness Rotator Cuff Tears in Overhead Athletes. Curr Rev Musculoskelet Med 2018; 11:55-62. [PMID: 29330670 DOI: 10.1007/s12178-018-9459-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW To review the etiology, classification, presentation, evaluation, treatment strategy, and outcomes in overhead athletes with partial thickness rotator cuff tears. RECENT FINDINGS Despite advances in surgical repair techniques, return to play following surgical repair of partial rotator cuff tears remains modest at best. Overhead athletes may be particularly prone to rotator cuff pathology due to the supraphysiological strains within the tendon during the throwing motion, as well as mechanical stress with contact between the undersurface of the rotator cuff and the glenoid. The true prevalence of partial tears may be underestimated given the high incidence of asymptomatic tears. Both dynamic ultrasound and enhanced contrast MRI have improved our understanding of this pathology. For most overhead athletes, nonoperative management is the most common course. Despite advances in imaging, diagnosis, and surgical techniques, our ability to return these patients to their elite level is modest at best when nonoperative management fails and surgical treatment is performed. If a surgical route is needed, debridement alone is the most frequent procedure given concerns of over constraint and poor return to play with surgical repair of the partial thickness rotator cuff tear.
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Affiliation(s)
- Joseph N Liu
- Section of Sports Medicine, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 200, Chicago, IL, 60612, USA.
| | - Grant H Garcia
- Section of Sports Medicine, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 200, Chicago, IL, 60612, USA
| | - Anirudh K Gowd
- Section of Sports Medicine, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 200, Chicago, IL, 60612, USA
| | - Brandon C Cabarcas
- Section of Sports Medicine, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 200, Chicago, IL, 60612, USA
| | - Michael D Charles
- Section of Sports Medicine, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 200, Chicago, IL, 60612, USA
| | - Anthony A Romeo
- Section of Sports Medicine, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 200, Chicago, IL, 60612, USA
| | - Nikhil N Verma
- Section of Sports Medicine, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 200, Chicago, IL, 60612, USA
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15
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Lee MH, Sheehan SE, Orwin JF, Lee KS. Comprehensive Shoulder US Examination: A Standardized Approach with Multimodality Correlation for Common Shoulder Disease. Radiographics 2017; 36:1606-1627. [PMID: 27726738 DOI: 10.1148/rg.2016160030] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Shoulder pain is one of the most common musculoskeletal conditions encountered in primary care and specialty orthopedic clinic settings. Although magnetic resonance (MR) imaging is typically the modality of choice for evaluating the soft-tissue structures of the shoulder, ultrasonography (US) is becoming an important complementary imaging tool in the evaluation of superficial soft-tissue structures such as the rotator cuff, subacromial-subdeltoid bursa, and biceps tendon. The advantages of US driving its recent increased use include low cost, accessibility, and capability for real-time high-resolution imaging that enables dynamic assessment and needle guidance. As more radiologists are considering incorporating shoulder US into their practices, the development of a standardized approach to performing shoulder US should be a priority to facilitate the delivery of high-quality patient care. Familiarity with and comfort in performing a standardized shoulder US examination, as well as knowledge of the types of anomalies that can be evaluated well with US, will enhance the expertise of those working in musculoskeletal radiology practices and add value in the form of increased patient and health care provider satisfaction. This review describes the utility and benefits of shoulder US as a tool that complements MR imaging in the assessment of shoulder pain. A standardized approach to the shoulder US examination is also described, with a review of the basic technique of this examination, normal anatomy of the shoulder, common indications for shoulder US, and characteristic US findings of common shoulder diseases-with select MR imaging and arthroscopic correlation. Online supplemental material is available for this article. ©RSNA, 2016.
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Affiliation(s)
- Matthew H Lee
- From the Departments of Radiology (M.H.L., S.E.S., K.S.L.) and Orthopedics and Rehabilitation (J.F.O.), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Scott E Sheehan
- From the Departments of Radiology (M.H.L., S.E.S., K.S.L.) and Orthopedics and Rehabilitation (J.F.O.), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - John F Orwin
- From the Departments of Radiology (M.H.L., S.E.S., K.S.L.) and Orthopedics and Rehabilitation (J.F.O.), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kenneth S Lee
- From the Departments of Radiology (M.H.L., S.E.S., K.S.L.) and Orthopedics and Rehabilitation (J.F.O.), University of Wisconsin School of Medicine and Public Health, Madison, WI
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16
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Tamborrini G, Möller I, Bong D, Miguel M, Marx C, Müller AM, Müller-Gerbl M. The Rotator Interval - A Link Between Anatomy and Ultrasound. Ultrasound Int Open 2017; 3:E107-E116. [PMID: 28845477 DOI: 10.1055/s-0043-110473] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/24/2017] [Accepted: 04/23/2017] [Indexed: 02/08/2023] Open
Abstract
Shoulder pathologies of the rotator cuff of the shoulder are common in clinical practice. The focus of this pictorial essay is to discuss the anatomical details of the rotator interval of the shoulder, correlate the anatomy with normal ultrasound images and present selected pathologies. We focus on the imaging of the rotator interval that is actually the anterosuperior aspect of the glenohumeral joint capsule that is reinforced externally by the coracohumeral ligament, internally by the superior glenohumeral ligament and capsular fibers which blend together and insert medially and laterally to the bicipital groove. In this article we demonstrate the capability of high-resolution musculoskeletal ultrasound to visualize the detailed anatomy of the rotator interval. MSUS has a higher spatial resolution than other imaging techniques and the ability to examine these structures dynamically and to utilize the probe for precise anatomic localization of the patient's pain by sono-palpation.
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Affiliation(s)
- Giorgio Tamborrini
- Ultrasound Center, Rheumatology, Basel, Switzerland.,EULAR Study Group on Anatomy for the Image
| | - Ingrid Möller
- Instituto Poal de Reumatologia, BCN Sonoanatomy group, Barcelona, Spain.,EULAR Study Group on Anatomy for the Image
| | - David Bong
- BCN Sonoanatomy group, Rheumatology, Barcelona, Spain.,EULAR Study Group on Anatomy for the Image
| | - Maribel Miguel
- Departamento de Patología y Terapéutica Experimental, University of Barcelona, Barcelona, Spain
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17
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Baumer TG, Dischler J, Mende V, Zauel R, van Holsbeeck M, Siegal DS, Divine G, Moutzouros V, Bey MJ. Effects of asymptomatic rotator cuff pathology on in vivo shoulder motion and clinical outcomes. J Shoulder Elbow Surg 2017; 26:1064-1072. [PMID: 28131679 PMCID: PMC5438772 DOI: 10.1016/j.jse.2016.11.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/15/2016] [Accepted: 11/25/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The incidence of asymptomatic rotator cuff tears has been reported to range from 15% to 39%, but the influence of asymptomatic rotator cuff pathology on shoulder function is not well understood. This study assessed the effects of asymptomatic rotator cuff pathology on shoulder kinematics, strength, and patient-reported outcomes. METHODS A clinical ultrasound examination was performed in 46 asymptomatic volunteers (age: 60.3 ± 7.5 years) with normal shoulder function to document the condition of their rotator cuff. The ultrasound imaging identified the participants as healthy (n = 14) or pathologic (n = 32). Shoulder motion was measured with a biplane x-ray imaging system, strength was assessed with a Biodex (Biodex Medical Systems, Inc., Shirley, NY, USA), and patient-reported outcomes were assessed using the Western Ontario Rotator Cuff Index and visual analog scale pain scores. RESULTS Compared with healthy volunteers, those with rotator cuff pathology had significantly less abduction (P = .050) and elevation (P = .041) strength, their humerus was positioned more inferiorly on the glenoid (P = .018), and the glenohumeral contact path length was longer (P = .007). No significant differences were detected in the Western Ontario Rotator Cuff Index, visual analog scale, range of motion, or acromiohumeral distance. CONCLUSIONS The differences observed between the healthy volunteers and those with asymptomatic rotator cuff pathology lend insight into the changes in joint mechanics, shoulder strength, and conventional clinical outcomes associated with the early stages of rotator cuff pathology. Furthermore, these findings suggest a plausible mechanical progression of kinematic and strength changes associated with the development of rotator cuff pathology.
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Affiliation(s)
- Timothy G Baumer
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA.
| | - Jack Dischler
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
| | - Veronica Mende
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
| | - Roger Zauel
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
| | | | - Daniel S Siegal
- Department of Radiology, Henry Ford Health System, Detroit, MI, USA
| | - George Divine
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Vasilios Moutzouros
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Michael J Bey
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
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Okoroha KR, Mehran N, Duncan J, Washington T, Spiering T, Bey MJ, Van Holsbeeck M, Moutzouros V. Characterization of Rotator Cuff Tears: Ultrasound Versus Magnetic Resonance Imaging. Orthopedics 2017; 40:e124-e130. [PMID: 27755645 DOI: 10.3928/01477447-20161013-04] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/30/2016] [Indexed: 02/03/2023]
Abstract
Ultrasound and magnetic resonance imaging (MRI) are both capable of diagnosing full-thickness rotator cuff tears. However, it is unknown which imaging modality is more accurate and precise in evaluating the characteristics of full-thickness rotator cuff tears in a surgical population. This study reviewed 114 patients who underwent arthroscopic repair of a full-thickness rotator cuff tear over a 1-year period. Of these patients, 61 had both preoperative MRI and ultrasound for review. Three musculoskeletal radiologists evaluated each ultrasound and MRI in a randomized and blinded fashion on 2 separate occasions. Tear size, retraction status, muscle atrophy, and fatty infiltration were analyzed and compared between the 2 modalities. Ultrasound measurements were statistically smaller in both tear size (P=.001) and retraction status (P=.001) compared with MRI. The 2 image modalities showed comparable intraobserver reliability in assessment of tear size and retraction status. However, MRI showed greater interobserver reliability in assessment of tear size, retraction status, and atrophy. Independent observers are more likely to agree on measurements of the characteristics of rotator cuff tears when using MRI compared with ultrasound. As tear size increases, the 2 image modalities show greater differences in measurement of tear size and retraction status. Additionally, compared with MRI, ultrasound shows consistently low reliability in detecting subtle, but clinically important, degeneration of the soft tissue envelope. Although it is inexpensive and convenient, ultrasound may be best used to identify a tear, and MRI is superior for use in surgical planning for larger tears. [Orthopedics. 2017; 40(1):e124-e130.].
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Möller I, Szkudlarek M. Imaging of regional pain syndromes; from syndromes to conditions using imaging? Best Pract Res Clin Rheumatol 2016; 30:707-719. [PMID: 27931963 DOI: 10.1016/j.berh.2016.06.001] [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: 05/24/2016] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 11/17/2022]
Abstract
Musculoskeletal regional pain syndromes often lead to patient referrals in general and rheumatological practice. Detailed history taking and clinical examination can in most cases reveal the cause for pain and direct the subsequent management of the conditions. Yet, when in doubt, imaging methods have to support the clinical assessment. This paper presents the underlying pathologies of the most frequently encountered regional pain syndromes and the role of musculoskeletal ultrasonography and magnetic resonance imaging in their visualization. It presents data, where available, on diagnostic accuracy and comparisons with gold standards. The article stresses the advantages and disadvantages of the analyzed imaging modalities and suggests the future research agenda.
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Affiliation(s)
- Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain; Department of Rheumatology, Zealand's University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
| | - Marcin Szkudlarek
- Department of Rheumatology, Zealand's University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
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20
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Amoo-Achampong K, Nwachukwu BU, McCormick F. An orthopedist's guide to shoulder ultrasound: a systematic review of examination protocols. PHYSICIAN SPORTSMED 2016; 44:407-416. [PMID: 27548649 DOI: 10.1080/00913847.2016.1222224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The utilization of musculoskeletal ultrasound has expanded within the setting of the orthopedic clinic as a cost-effective, point-of-care diagnostic tool for shoulder pathology. In experienced hands, ultrasound exhibits capabilities equivalent to that of magnetic resonance imaging in the diagnosis of many shoulder diseases including full-thickness and partial-thickness rotator cuff tears. Although similarly effective in identifying additional shoulder disease processes, major obstacles to its widespread use include user dependence and intrinsic limitation to extra-articular diagnosis. OBJECTIVES The purpose of this review is to present a step-by-step guide of how to perform a comprehensive shoulder examination and to discuss the appropriate use, economic benefit and implementation of ultrasound within the clinic. METHODS A systematic search (June 2016) of PubMed, Scopus, and EMBASE databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for literature presenting shoulder ultrasound examination protocols. Included studies were peer-reviewed articles or academic society endorsed protocols presenting comprehensive sonographic examinations of the adult shoulder. Papers with limited or single structure examination descriptions, non-English language, and publication dates before 1980 were excluded. Final papers meeting criteria were secondarily screened for publication after 2005 to reflect the current state of ultrasound imaging. RESULTS AND CONCLUSIONS The search yielded 1,725 unique articles with 17 studies meeting final selection criteria. Information from identified studies was summarized to formulate a 4-part shoulder examination protocol, including steps most pertinent to orthopedic in-office diagnoses. In agreement with previous studies, the inexperienced orthopedic surgeon can be quickly trained to expert level proficiency in shoulder ultrasound diagnosis. Using an established protocol, a comprehensive, yet effective shoulder ultrasound examination can be performed within ten minutes. Further, ultrasound provides opportunity to off-set costs through the engagement of revenue generating activity for the orthopedic practice.
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Affiliation(s)
- Kelms Amoo-Achampong
- a Sports Medicine and Shoulder Division , SOAR Institute , Pompano Beach , FL , USA
| | - Benedict U Nwachukwu
- b Department of Orthopaedic Surgery , Hospital for Special Surgery , New York , NY , USA
| | - Frank McCormick
- a Sports Medicine and Shoulder Division , SOAR Institute , Pompano Beach , FL , USA
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21
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Alilet M, Behr J, Nueffer JP, Barbier-Brion B, Aubry S. Multi-modal imaging of the subscapularis muscle. Insights Imaging 2016; 7:779-791. [PMID: 27752837 PMCID: PMC5110480 DOI: 10.1007/s13244-016-0526-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/06/2016] [Accepted: 09/28/2016] [Indexed: 12/23/2022] Open
Abstract
Abstract The subscapularis (SSC) muscle is the most powerful of the rotator cuff muscles, and plays an important role in shoulder motion and stabilization. SSC tendon tear is quite uncommon, compared to the supraspinatus (SSP) tendon, and, most of the time, part of a large rupture of the rotator cuff. Various complementary imaging techniques can be used to obtain an accurate diagnosis of SSC tendon lesions, as well as their extension and muscular impact. Pre-operative diagnosis by imaging is a key issue, since a lesion of the SSC tendon impacts on treatment, surgical approach, and post-operative functional prognosis of rotator cuff injuries. Radiologists should be aware of the SSC anatomy, variability in radiological presentation of muscle or tendon injury, and particular mechanisms that may lead to a SSC injury, such as coracoid impingement. Teaching Points • Isolated subscapularis (SSC) tendon tears are uncommon. • Classically, partial thickness SSC tendon tears start superomedially and progress inferolaterally. • Long head of biceps tendon medial dislocation can indirectly signify SSC tendon tears. • SSC tendon injury is associated with anterior shoulder instability. • Dynamic ultrasound study of the SSC helps to diagnose coracoid impingement.
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Affiliation(s)
- Mona Alilet
- Department of Musculoskeletal Imaging, CHRU de Besançon, CHRU Jean Minjoz, Boulevard Fleming, 25030, Besançon Cedex, France
| | - Julien Behr
- Anatomy Laboratory, University of Franche-Comte, Besançon, France
| | - Jean-Philippe Nueffer
- Department of Musculoskeletal Imaging, CHRU de Besançon, CHRU Jean Minjoz, Boulevard Fleming, 25030, Besançon Cedex, France
| | | | - Sébastien Aubry
- Department of Musculoskeletal Imaging, CHRU de Besançon, CHRU Jean Minjoz, Boulevard Fleming, 25030, Besançon Cedex, France.
- Nanomedicine and Imagery Laboratory, EA4662, University of Franche-Comte, Besançon, France.
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22
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Tamborrini G, Marx C, Micheroli R. Inter-rater reliability in the classification of supraspinatus tendon tears using 3D ultrasound - a question of experience? J Ultrason 2016; 16:252-9. [PMID: 27679728 PMCID: PMC5034019 DOI: 10.15557/jou.2016.0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 04/02/2016] [Accepted: 04/06/2016] [Indexed: 11/29/2022] Open
Abstract
Background Three-dimensional (3D) ultrasound of the shoulder is characterized by a comparable accuracy to two-dimensional (2D) ultrasound. No studies investigating 2D versus 3D inter-rater reliability in the detection of supraspinatus tendon tears taking into account the level of experience of the raters have been carried out so far. Objectives The aim of this study was to determine the inter-rater reliability in the analysis of 3D ultrasound image sets of the supraspinatus tendon between sonographer with different levels of experience. Patients and methods Non-interventional, prospective, observational pilot study of 2309 images of 127 adult patients suffering from unilateral shoulder pain. 3D ultrasound image sets were scored by three raters independently. The intra-and interrater reliabilities were calculated. Results There was an excellent intra-rater reliability of rater A in the overall classification of supraspinatus tendon tears (2D vs 3D κ = 0.892, pairwise reliability 93.81%, 3D scoring round 1 vs 3D scoring round 2 κ = 0.875, pairwise reliability 92.857%). The inter-rater reliability was only moderate compared to rater B on 3D (κ = 0.497, pairwise reliability 70.95%) and fair compared to rater C (κ = 0.238, pairwise reliability 42.38%). Conclusions The reliability of 3D ultrasound of the supraspinatus tendon depends on the level of experience of the sonographer. Experience in 2D ultrasound does not seem to be sufficient for the analysis of 3D ultrasound imaging sets. Therefore, for a 3D ultrasound analysis new diagnostic criteria have to be established and taught even to experienced 2D sonographers to improve reproducibility.
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Affiliation(s)
- Giorgio Tamborrini
- Ultrasound Center and Rheumatology Department, Bethesda Hospital Basel, Switzerland
| | - Christian Marx
- Ultrasound Center and Rheumatology Department, Bethesda Hospital Basel, Switzerland
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23
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Chang RF, Lee CC, Lo CM. Computer-Aided Diagnosis of Different Rotator Cuff Lesions Using Shoulder Musculoskeletal Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2315-2322. [PMID: 27381057 DOI: 10.1016/j.ultrasmedbio.2016.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 04/18/2016] [Accepted: 05/18/2016] [Indexed: 06/06/2023]
Abstract
The lifetime prevalence of shoulder pain approaches 70%, which is mostly attributable to rotator cuff lesions such as inflammation, calcific tendinitis and tears. On clinical examination, shoulder ultrasound is recommended for the detection of lesions. However, there exists inter-operator variability in diagnostic accuracy because of differences in the experience and expertise of operators. In this study, a computer-aided diagnosis (CAD) system was developed to assist ultrasound operators in diagnosing rotator cuff lesions and to improve the practicality of ultrasound examination. The collected cases included 43 cases of inflammation, 30 cases of calcific tendinitis and 26 tears. For each case, the lesion area and texture features were extracted from the entire lesions and combined in a multinomial logistic regression classifier for lesion classification. The proposed CAD achieved an accuracy of 87.9%. The individual accuracy of this CAD system was 88.4% for inflammation, 83.3% for calcific tendinitis and 92.3% for tears. Cohen's k was 0.798. On the basis of its diagnostic performance, clinical use of this CAD technique has promise.
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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.
| | - Chung-Ming Lo
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
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24
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Kurz AZ, Kelly MJ, Hackett L, Murrell GAC. Effect of surgeon-sonographer interaction on ultrasound diagnosis of rotator cuff tears: a five-year cohort study in 775 shoulders. J Shoulder Elbow Surg 2016; 25:1385-94. [PMID: 27424254 DOI: 10.1016/j.jse.2016.04.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 04/09/2016] [Accepted: 04/16/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ultrasonography for the diagnosis of rotator cuff tears has been a topic of debate for years. The literature shows promising results for the diagnostic utility of ultrasonography for rotator cuff tears. This study assessed the effect of a surgeon-sonographer interaction on the ability of ultrasonography to predict the presence or absence of rotator cuff tears. METHODS This study was a temporal cohort analysis of 775 patients to detect the diagnostic accuracy of ultrasonography at predicting a rotator cuff tear. The surgeon-sonographer interaction had three components: (1) presence of an ultrasound machine and ultrasonographer within a shoulder clinic, (2) the ultrasonographer attends shoulder operations, (3) and the ultrasonographer reviews patients preoperatively and postoperatively. Comparisons of 2 variables-presence and size of a tear-were made between the preoperative ultrasonographic findings with arthroscopic findings (gold standard). RESULTS The diagnostic utility for the detection of rotator cuff tears by ultrasonography at the start of the study was 93% sensitive and 68% specific, and at the end of the study was 99% sensitive and 93% specific. There was an improvement in the correlation of the ability to estimate the size of rotator cuff tears from ultrasonography to surgery in both full- and partial-thickness tears. CONCLUSIONS The surgeon-sonographer interaction improved the diagnostic utility of an office-based ultrasonographer over time, particularly with respect to the overall accuracy of ultrasonography for the detection of rotator cuff tears and for the ability to predict the size of full- and partial-thickness rotator cuff tears.
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Affiliation(s)
- Adrian Z Kurz
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada; Orthopaedic Research Institute, University of New South Wales, St George Hospital, Sydney, NSW, Australia
| | - Matthew J Kelly
- Orthopaedic Research Institute, University of New South Wales, St George Hospital, Sydney, NSW, Australia; Orthopaedic Institute of Pennsylvania, Harrisburg, PA, USA
| | - Lisa Hackett
- Orthopaedic Research Institute, University of New South Wales, St George Hospital, Sydney, NSW, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, University of New South Wales, St George Hospital, Sydney, NSW, Australia.
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25
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Jeong WK. Usefulness of musculoskeletal ultrasonography for treatment of shoulder pain. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2016. [DOI: 10.5124/jkma.2016.59.3.205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Woong Kyo Jeong
- Department of Orthopedic Surgery, Korea University College of Medicine, Seoul, Korea
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26
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Ali F, Hamdy M, Abdel-Magied RA, Elian MM. Musculoskeletal ultrasonographic findings of the affected and unaffected shoulders in hemiplegic patients. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2016. [DOI: 10.4103/1110-161x.177421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Moon SH, Ko KP, Baek SI, Lee S. Ultrasonography and Ultrasound-guided Interventions of the Shoulder. Clin Shoulder Elb 2015. [DOI: 10.5397/cise.2015.18.3.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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28
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Benítez-Martínez J, Casaña-Granell J, Alakhdar-Mohamara Y, Espí-López G. Diferencias en el espacio acromio-humeral medido ecográficamente en el dolor de hombro del deportista lanzador. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ft.2014.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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29
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The effect of percutaneous ultrasound-guided subacromial bursography using microbubbles in the assessment of subacromial impingement syndrome: initial experience. Eur Radiol 2015; 25:2412-8. [PMID: 25744624 DOI: 10.1007/s00330-015-3638-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/14/2015] [Accepted: 01/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the feasibility and the value of percutaneous ultrasound-guided subacromial bursography (PUSB) with contrast-enhanced ultrasound (CEUS) for assessment of rotator cuff tears. METHODS Between January 2012 and September 2014, 2-D US and PUSB were prospectively performed in 135 patients with suspected rotator cuff tears from among 2,169 patients with clinically diagnosed subacromial impingement syndrome. Sixty-three patients who had undergone arthroscopy were included. The PUSB findings were compared with those from 2-D US using the McNemar test, with arthroscopy as a standard. RESULTS Of a total of 19 full-thickness tears (FTTs), 2-D US correctly diagnosed 12 and PUSB correctly diagnosed 18 (P = 0.031). With regard to partial-thickness tears, 2-D US correctly diagnosed 31 and PUSB 35 of a total of 41 tears (P = 0.375).Accuracy in diagnosing FTTs was 81.0 % for 2-D US and 98.4 % for PUSB. 2-D US and PUSB yielded sensitivity of 63.2 % and 94.7 %, respectively, for full-thickness tears, with specificity of 88.6 % and 100.0 %, respectively. CONCLUSIONS PUSB is a safe and feasible procedure, with greater sensitivity and specificity than 2D US in diagnosing FTTs As such, PUSB improves the value of ultrasound for assessing rotator cuff pathology. KEY POINTS • PUSB allows new application of CEUS and offers a new form of bursography. • PUSB appears to facilitate diagnosis of full -thickness rotator cuff tears. • PUSB outlines the rotator cuff tears more clearly than 2-D US.
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Roy JS, Braën C, Leblond J, Desmeules F, Dionne CE, MacDermid JC, Bureau NJ, Frémont P. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med 2015; 49:1316-28. [PMID: 25677796 PMCID: PMC4621376 DOI: 10.1136/bjsports-2014-094148] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 01/14/2015] [Indexed: 12/12/2022]
Abstract
Background Different diagnostic imaging modalities, such as ultrasonography (US), MRI, MR arthrography (MRA) are commonly used for the characterisation of rotator cuff (RC) disorders. Since the most recent systematic reviews on medical imaging, multiple diagnostic studies have been published, most using more advanced technological characteristics. The first objective was to perform a meta-analysis on the diagnostic accuracy of medical imaging for characterisation of RC disorders. Since US is used at the point of care in environments such as sports medicine, a secondary analysis assessed accuracy by radiologists and non-radiologists. Methods A systematic search in three databases was conducted. Two raters performed data extraction and evaluation of risk of bias independently, and agreement was achieved by consensus. Hierarchical summary receiver-operating characteristic package was used to calculate pooled estimates of included diagnostic studies. Results Diagnostic accuracy of US, MRI and MRA in the characterisation of full-thickness RC tears was high with overall estimates of sensitivity and specificity over 0.90. As for partial RC tears and tendinopathy, overall estimates of specificity were also high (>0.90), while sensitivity was lower (0.67–0.83). Diagnostic accuracy of US was similar whether a trained radiologist, sonographer or orthopaedist performed it. Conclusions Our results show the diagnostic accuracy of US, MRI and MRA in the characterisation of full-thickness RC tears. Since full thickness tear constitutes a key consideration for surgical repair, this is an important characteristic when selecting an imaging modality for RC disorder. When considering accuracy, cost, and safety, US is the best option.
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Affiliation(s)
- Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada
| | - Caroline Braën
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada
| | - Jean Leblond
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada
| | - François Desmeules
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada Faculty of Medicine, School of Rehabilitation, Université de Montreal, Montreal, Quebec, Canada
| | - Clermont E Dionne
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada Centre de recherche du Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | - Joy C MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Nathalie J Bureau
- Department of Radiology, Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Frémont
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada Centre de recherche du Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
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Fischer CA, Weber MA, Neubecker C, Bruckner T, Tanner M, Zeifang F. Ultrasound vs. MRI in the assessment of rotator cuff structure prior to shoulder arthroplasty. J Orthop 2015; 12:23-30. [PMID: 25829757 DOI: 10.1016/j.jor.2015.01.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/04/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS We compared the accuracy of US to 3 T Tesla MRI for the detection of rotator cuff and long biceps tendon pathologies before joint replacement. METHODS 45 patients were prospectively included. RESULTS For the supraspinatus tendon, the accuracy of US when using MRI as reference was 91.1%. For the infraspinatus tendon, the accuracy with MRI as reference was 84.4%. The subscapularis tendon was consistently assessed by US and MRI in 35/45 patients (accuracy 77.8%). For the long biceps tendon the accuracy was 86.7%. CONCLUSION US detection of rotator cuff and biceps tendon integrity is comparable to MRI and should be preferred in revision cases.
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Affiliation(s)
- Christian Alexander Fischer
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, BW, 69118, Germany
| | - Marc-André Weber
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, BW, 69120, Germany
| | - Clément Neubecker
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, BW, 69118, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, BW, 69120, Germany
| | - Michael Tanner
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, BW, 69118, Germany
| | - Felix Zeifang
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, BW, 69118, Germany
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Mohamed RE, Amin MA, Aboelsafa AA. Ultrasonographic and clinical study of post-stroke painful hemiplegic shoulder. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Görmeli C, Görmeli G, Yücesoy C, Ataoglu B, Kanatli U. Comparison of the results of ultrasonographic evaluation and arthroscopy in patients scheduled for surgery of the supraspinatus tendon rupture. Ann Saudi Med 2014; 34:522-6. [PMID: 25971827 PMCID: PMC6074584 DOI: 10.5144/0256-4947.2014.522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study aims to compare the findings of the shoulder ultrasonography (US) of patients with a supraspinatus (SS) tendon rupture with those of the shoulder arthroscopy, to determine the reliability and diagnostic performance of the shoulder US in the algorithm of the SS tendon pathologic lesions and their secondary ultrasonographic findings. DESIGN AND SETTINGS A prospective study conducted with patients scheduled for arthroscopy of the shoulder due to an SS tendon rupture in Yildirm Beyazit Education and Research Center and Gazi University, Ankara, Turkey. MATERIALS AND METHODS Fifty patients scheduled for an arthroscopy of the shoulder due to an SS tendon rupture were evaluated by shoulder US 1 week before the surgery. SS tendon pathologic lesions (tendinosis, partial tears, and full-thickness tears) and humeral degeneration were recorded, and the results of shoulder US were compared with those of arthroscopy. RESULTS With reference to the arthroscopic data, the sensitivity of the ultrasonographic evaluation for the diagnosis of a full-thickness SS tendon rupture was 91%, with a specificity of 88%; the sensitivity for the diagnosis of a partial-thickness rupture was 86%, with a specificity of 82%; and the sensitivity for the diagnosis of a tendinosis was 98%, with a specificity of 71%. With reference to the arthroscopic data, the sensitivity of US for the diagnosis of humeral degeneration was 93%, with a specificity of 91%. CONCLUSION The high sensitivity and specificity rates of US in detecting SS tendon rupture and its secondary imaging findings make it an efficient and reliable diagnostic modality, which should be preferred to other more expensive and more invasive methods in the algorithm.
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Affiliation(s)
- Cemille Görmeli
- Cemille Görmeli, MD, Department of Radiology, Inonu University,, Turgut Ozal Medical School, Malatya 44160, Turkey,
| | - Gökay Görmeli
- Cemille Görmeli, MD, Department of Radiology, Inonu University,, Turgut Ozal Medical School, Malatya 44160, Turkey,
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Chang KV, Chen WS, Wang TG, Hung CY, Chien KL. Associations of sonographic abnormalities of the shoulder with various grades of biceps peritendinous effusion (BPE). ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:313-321. [PMID: 24315393 DOI: 10.1016/j.ultrasmedbio.2013.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 09/26/2013] [Accepted: 10/03/2013] [Indexed: 06/02/2023]
Abstract
Bicipital peritendinous effusion (BPE), a common ultrasonographic finding of the long head of the biceps tendon, may be associated with shoulder joint derangement, but supporting evidence from large-scale studies is lacking. The aim of this cross-sectional study was to determine the strength of the association between BPE and sonographic abnormalities of the shoulder joint. We reviewed the sonographic reports of patients with suspected shoulder disorders investigated ultrasonographically between January 2011 and January 2012. BPE was graded according to its measured thickness as absent (<1 mm), mild (1-2 mm), moderate (2-3 mm) or severe (>3 mm). The associations between BPE and sonographic abnormalities were examined using multinomial logistic regression adjusted for age, gender, affected side and clinical diagnosis of frozen shoulder. The prevalence rates of absent, mild, moderate and severe BPE among the 907 shoulders examined were 64.1%, 17.8%, 10.4% and 7.7%, respectively. Frozen shoulder was associated with mild BPE (relative risk [RR] vs. participants without BPE = 1.83, 95% confidence interval [CI] = 1.28-2.50). Sonographic findings of biceps tendinopathy, subdeltoid bursitis and full-thickness tears of the supraspinatus tendon were significantly associated with the entire spectrum of BPE, whereas subscapularis tendon tears were significantly associated with moderate (RR = 2.47, 95% CI = 1.29-4.69) and severe (RR = 3.11, 95% CI = 1.51-6.33) BPE. Severe BPE was associated with articular-sided partial-thickness tears of the supraspinatus tendon (RR = 14.32, 95% CI = 4.30-34.35), posterior recess effusion (RR, 7.98, 95% CI = 1.44-34.93) and biceps medial subluxation (RR = 7.25, 95% CI = 1.90-22.33). Our study indicates that BPE is related to various shoulder abnormalities and that the strengths of these associations depend on the severity of BPE. Clinicians encountering BPE should grade its severity and be alert for hidden lesions of the shoulder joint.
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch, and National Taiwan University College of Medicine, Tapei, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chen-Yu Hung
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Abstract
Aside from its prompt use in musculoskeletal injuries (sports lesions, degenerative/inflammatory joint disorders, and peripheral nerve pathologies), ultrasonographic imaging can be used quite conveniently in various types of rehabilitation conditions as well. If used in a rehabilitation setting, ultrasound can significantly contribute to the diagnostic/therapeutic algorithm of rehabilitation patients. Accordingly, in this article, the authors focus on the diagnostic/interventional utility of ultrasound particularly for shoulder problems, overuse injuries of wheelchair users, heterotopic ossification, amputee follow-up, peripheral nerve and botulinum toxin injections, and diaphragm imaging/electromyography.
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Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NCA, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev 2013; 2013:CD009020. [PMID: 24065456 PMCID: PMC6464715 DOI: 10.1002/14651858.cd009020.pub2] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Shoulder pain is a very common symptom. Disorders of the rotator cuff tendons due to wear or tear are among the most common causes of shoulder pain and disability. Magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA) and ultrasound (US) are increasingly being used to assess the presence and size of rotator cuff tears to assist in planning surgical treatment. It is not known whether one imaging method is superior to any of the others. OBJECTIVES To compare the diagnostic test accuracy of MRI, MRA and US for detecting any rotator cuff tears (i.e. partial or full thickness) in people with suspected rotator cuff tears for whom surgery is being considered. SEARCH METHODS We searched the Cochrane Register of Diagnostic Test Accuracy Studies, MEDLINE, EMBASE, and LILACS from inception to February 2011. We also searched trial registers, conference proceedings and reference lists of articles to identify additional studies. No language or publication restrictions were applied. SELECTION CRITERIA We included all prospective diagnostic accuracy studies that assessed MRI, MRA or US against arthroscopy or open surgery as the reference standard, in people suspected of having a partial or full thickness rotator cuff tear. We excluded studies that selected a healthy control group, or participants who had been previously diagnosed with other specific causes of shoulder pain such as osteoarthritis or rheumatoid arthritis. Studies with an excessively long period (a year or longer) between the index and reference tests were also excluded. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data on study characteristics and results of included studies, and performed quality assessment according to QUADAS criteria. Our unit of analysis was the shoulder. For each test, estimates of sensitivity and specificity from each study were plotted in ROC space and forest plots were constructed for visual examination of variation in test accuracy. Meta-analyses were performed using the bivariate model to produce summary estimates of sensitivity and specificity. We were unable to formally investigate potential sources of heterogeneity because of the small number of studies. MAIN RESULTS We included 20 studies of people with suspected rotator cuff tears (1147 shoulders), of which six evaluated MRI and US (252 shoulders), or MRA and US (127 shoulders) in the same people. Many studies had design flaws, with the potential for bias, thus limiting the reliability of their findings. Overall, the methodological quality of the studies was judged to be low or unclear. For each test, we observed considerable heterogeneity in study results, especially between studies that evaluated US for the detection of full thickness tears and studies that evaluated MRA for the detection of partial thickness tears. The criteria for a positive diagnostic test (index tests and reference standard) varied between studies.Meta-analyses were not possible for studies that assessed MRA for detection of any rotator cuff tears or partial thickness tears. We found no statistically significant differences in sensitivity or specificity between MRI and US for detecting any rotator cuff tears (P = 0.13), or for detecting partial thickness tears (P = 1.0). Similarly, for the comparison between MRI, MRA and US for detecting full thickness tears, there was no statistically significant difference in diagnostic performance (P = 0.7). For any rotator cuff tears, the summary sensitivity and specificity were 98% (95% CI 92% to 99%) and 79% (95% CI 68% to 87%) respectively for MRI (6 studies, 347 shoulders), and 91% (95% CI 83% to 95%) and 85% (95% CI 74% to 92%) respectively for US (13 studies, 854 shoulders). For full thickness tears, the summary sensitivity and specificity were 94% (95% CI 85% to 98%) and 93% (95% CI 83% to 97%) respectively for MRI (7 studies, 368 shoulders); 94% (95% CI 80% to 98%) and 92% (95% CI 83% to 97%) respectively for MRA (3 studies, 183 shoulders); and 92% (95% CI 82% to 96%) and 93% (95% CI 81% to 97%) respectively for US (10 studies, 729 shoulders).Because few studies were direct head-to-head comparisons, we could not perform meta-analyses restricted to these studies. The test comparisons for each of the three classifications of the target condition were therefore based on indirect comparisons which may be prone to bias due to confounding. AUTHORS' CONCLUSIONS MRI, MRA and US have good diagnostic accuracy and any of these tests could equally be used for detection of full thickness tears in people with shoulder pain for whom surgery is being considered. The diagnostic performance of MRI and US may be similar for detection of any rotator cuff tears. However, both MRI and US may have poor sensitivity for detecting partial thickness tears, and the sensitivity of US may be much lower than that of MRI. The strength of evidence for all test comparisons is limited because most studies were small, heterogeneous and methodologically flawed, and there were few comparative studies. Well designed studies that directly compare MRI, MRA and US for detection of rotator cuff tears are needed.
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Affiliation(s)
- Mário Lenza
- Hospital Israelita Albert EinsteinOrthopaedic and Trauma DepartmentAv. Albert Einstein, 627/701São PauloSao PauloBrazilCEP 05651‐901
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Yemisi Takwoingi
- University of BirminghamPublic Health, Epidemiology and BiostatisticsEdgbastonBirminghamUKB15 2TT
| | - Renea V Johnston
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Nigel CA Hanchard
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughTees ValleyUKTS1 3BA
| | - Flávio Faloppa
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 783‐5th FloorSão PauloSão PauloBrazil
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Ali Ou Alla S, Bahiri R, Amine H, El Alaoui H, Rkain H, Aktaou S, Abouqal R, Hajjaj-Hassouni N. Ultrasound features of shoulder involvement in patients with ankylosing spondylitis: a case-control study. BMC Musculoskelet Disord 2013; 14:272. [PMID: 24053556 PMCID: PMC3849072 DOI: 10.1186/1471-2474-14-272] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 09/18/2013] [Indexed: 11/10/2022] Open
Abstract
Background During Ankylosing spondylitis (AS) courses, shoulder involvement is common. However, etiologies of shoulder pain in patients with AS remain to be defined. The aim of this study was to investigate the prevalence of ultrasound (US) abnormalities in shoulders of patients with ankylosing spondylitis (AS), and to determine predictive factors of ultrasound shoulder enthesitis. Methods 38 patients with AS were included with 38 age and sex-matched healthy controls. All patients fulfilled the modified New York criteria for ankylosing spondylitis. Clinical and demographical data were recorded. US examination of bilateral shoulders was performed by a musculoskeletal sonographer according to a defined protocol that included imaging of the insertions of supraspinatus, subscapularis and infraspinatus tendons, rotator cuff tendons, subacromial-subdeltoid bursa, acromioclavicular joint, and glenohumeral joint. Results The mean age of patients and controls was 36 years, each group of patients and controls comprised 22 men (57.9%) and 16 women (42.1%). Disease duration was 9.6 ± 7.2 years. Among 38 patients with AS, 21 had coxitis (55%) and 19 had previous or current shoulder pain (50%). AS shoulders presented significantly more ultrasound enthesitis than controls shoulders (43 shoulders (56.6%) versus 8 shoulders (10.5%) respectively). Involvement of rotator cuff tendons was significantly higher in patients with AS compared with control subjects (16/38 (42.1%) versus 6 (15.2%) respectively). However, involvement of gleno-humeral and acromio-clavicular joints was infrequent in both groups. In patients with AS, we found that the presence of coxitis was the only significant predictive factors of shoulder enthesitis (Odds Ratio (OR) = 9.4; Confidence interval (CI) 95% (1.10; 81.9), p = 0.04). Conclusions Ultrasound abnormalities of shoulders are common in patients with AS, and the most frequent abnormalitie was enthesitis, which was associated with the presence of coxitis.
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Affiliation(s)
- Sanae Ali Ou Alla
- Department of Rheumatology, El Ayachi Hospital, University Hospital of Rabat-Sale, Rabat-Sale, Morocco.
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Aliprandi A, Sdao S, Cannaò PM, Khattak YJ, Longo S, Sconfienza LM, Sardanelli F. Imaging of shoulder pain in overhead throwing athletes. SPORT SCIENCES FOR HEALTH 2013. [DOI: 10.1007/s11332-013-0151-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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MARMERY H. Imaging the shoulder. IMAGING 2013. [DOI: 10.1259/imaging.20110061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Yablon CM, Bedi A, Morag Y, Jacobson JA. Ultrasonography of the shoulder with arthroscopic correlation. Clin Sports Med 2013; 32:391-408. [PMID: 23773874 DOI: 10.1016/j.csm.2013.03.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ultrasonography is a well-established and widely accepted modality for the evaluation of rotator cuff tears and injury to the biceps brachii tendon. Ultrasonography and magnetic resonance imaging have comparable sensitivity and specificity for diagnosing both full-thickness and partial-thickness rotator cuff tears. This article addresses the ultrasonographic diagnosis of abnormalities of the rotator cuff, rotator interval, and biceps brachii, with magnetic resonance imaging and arthroscopic correlation. Characteristic ultrasonographic findings as well as imaging pitfalls are reviewed.
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Affiliation(s)
- Corrie M Yablon
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Teefey SA. Shoulder sonography: why we do it. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1325-1331. [PMID: 22922611 DOI: 10.7863/jum.2012.31.9.1325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Sharlene A Teefey
- Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St Louis, MO 63110, USA.
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Abstract
MRI and ultrasound are now widely used for the assessment of tendon and ligament abnormalities. Healthy tendons and ligaments contain high levels of collagen with a structured orientation, which gives rise to their characteristic normal imaging appearances as well as causing particular imaging artefacts. Changes to ligaments and tendons as a result of disease and injury can be demonstrated using both ultrasound and MRI. These have been validated against surgical and histological findings. Novel imaging techniques are being developed that may improve the ability of MRI and ultrasound to assess tendon and ligament disease.
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Affiliation(s)
- R J Hodgson
- Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
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43
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Hayter CL, Miller TT, Nguyen JT, Adler RS. Comparative analysis of 2- versus 3-dimensional sonography of the supraspinatus tendon. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:449-453. [PMID: 22368135 DOI: 10.7863/jum.2012.31.3.449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the reliability in the analysis of images acquired using a dedicated 3-dimensional (3D) ultrasound transducer and conventional 2-dimensional (2D) images in the detection and characterization of supraspinatus tendon tears. METHODS Images of the supraspinatus tendon in 42 patients who had undergone 2D and 3D sonography were classified by two readers independently as no tear, full-thickness tear, or partial-thickness tear. When present, the tear size and location were recorded. Inter- and intra-rater reliability for the two data sets were calculated. RESULTS There was substantial agreement between the two readers in the classification of supraspinatus tendon tears on 2D images (κ = 0.79) but only moderate agreement on 3D images (κ = 0.48). There was moderate to substantial agreement in the classification of tears between the 2D and 3D images for both readers (reader 1, κ = 0.64; reader 2, κ= 0.54). The most common cause of a discordant result was the interpretation of a small hypoechoic region at the footprint as a partial tear on 3D images, compared to a normal appearance on 2D images. CONCLUSIONS Use of a dedicated 3D ultrasound transducer has poorer inter- and intra-rater reliability for the assessment of supraspinatus tendon tears compared to 2D sonography because of the interpretation of small partial-thickness tears at the footprint on 3D images, a common region affected by anisotropy.
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Affiliation(s)
- Catherine L Hayter
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
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Guerini H, Fermand M, Godefroy D, Feydy A, Chevrot A, Morvan G, Gault N, Drapé JL. US appearance of partial-thickness supraspinatus tendon tears: Application of the string theory. Pictorial essay. J Ultrasound 2012; 15:7-15. [PMID: 23396264 DOI: 10.1016/j.jus.2011.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
The supraspinatus tendon is composed of 5 different layers consisting of intertwining bundles. On a front portion of the tendon, the layers become coated bundles which insert on the trochanter. At the insertion, the superficial or bursal surface of the tendon corresponding to the tendon fibers in contact with the subacromial bursa can be distinguished from the deep surface corresponding to the fibers in contact with the glenohumeral joint. A tendon tear may involve partial or total disruption of the tendon fibers and is called full-thickness tear if it affects the entire tendon, and partial-thickness tear if it involves only part of the tendon. Partial-thickness tears of the supraspinatus tendon include lesions of the superficial, deep and central surface or tendon delamination.A contrast enhanced examination requires injection of contrast agent into the joint (arthrography followed by computed tomography (CT) or magnetic resonance imaging (MRI)) to study the deep surface, and injection into the subacromial bursa (bursography followed by CT) to study the superficial surface. MRI and ultrasound (US) examination allow the study of these different tendon layers without the use of contrast agent (which is not possible at CT).
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Affiliation(s)
- H Guerini
- Leonardo da Vinci Medical Imaging, Paris, France
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Bey MJ, Peltz CD, Ciarelli K, Kline SK, Divine GW, van Holsbeeck M, Muh S, Kolowich PA, Lock TR, Moutzouros V. In vivo shoulder function after surgical repair of a torn rotator cuff: glenohumeral joint mechanics, shoulder strength, clinical outcomes, and their interaction. Am J Sports Med 2011; 39:2117-29. [PMID: 21737834 PMCID: PMC4601100 DOI: 10.1177/0363546511412164] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical repair of a torn rotator cuff is based on the belief that repairing the tear is necessary to restore normal glenohumeral joint (GHJ) mechanics and achieve a satisfactory clinical outcome. HYPOTHESIS Dynamic joint function is not completely restored by rotator cuff repair, thus compromising shoulder function and potentially leading to long-term disability. STUDY DESIGN Controlled laboratory study and Case series; Level of evidence, 4. METHODS Twenty-one rotator cuff patients and 35 control participants enrolled in the study. Biplane radiographic images were acquired bilaterally from each patient during coronal-plane abduction. Rotator cuff patients were tested at 3, 12, and 24 months after repair of a supraspinatus tendon tear. Control participants were tested once. Glenohumeral joint kinematics and joint contact patterns were accurately determined from the biplane radiographic images. Isometric shoulder strength and patient-reported outcomes were measured at each time point. Ultrasound imaging assessed rotator cuff integrity at 24 months after surgery. RESULTS Twenty of 21 rotator cuff repairs appeared intact at 24 months after surgery. The humerus of the patients' repaired shoulder was positioned more superiorly on the glenoid than both the patients' contralateral shoulder and the dominant shoulder of control participants. Patient-reported outcomes improved significantly over time. Shoulder strength also increased over time, although strength deficits persisted at 24 months for most patients. Changes over time in GHJ mechanics were not detected for either the rotator cuff patients' repaired or contralateral shoulders. Clinical outcome was associated with shoulder strength but not GHJ mechanics. CONCLUSION Surgical repair of an isolated supraspinatus tear may be sufficient to keep the torn rotator cuff intact and achieve satisfactory patient-reported outcomes, but GHJ mechanics and shoulder strength are not fully restored with current repair techniques. CLINICAL RELEVANCE The study suggests that current surgical repair techniques may be effective for reducing pain but have not yet been optimized for restoring long-term shoulder function.
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Affiliation(s)
- Michael J. Bey
- Bone and Joint Center, Henry Ford Hospital, Detroit, Michigan
,Address correspondence to Michael J. Bey, PhD, Bone and Joint Center, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 ()
| | | | | | | | - George W. Divine
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | | | - Stephanie Muh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | | | - Terrence R. Lock
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
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Chen HS, Lin SH, Hsu YH, Chen SC, Kang JH. A comparison of physical examinations with musculoskeletal ultrasound in the diagnosis of biceps long head tendinitis. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1392-1398. [PMID: 21767902 DOI: 10.1016/j.ultrasmedbio.2011.05.842] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/06/2011] [Accepted: 05/26/2011] [Indexed: 05/31/2023]
Abstract
Provocative tests are useful in diagnosing biceps tendon tendinitis. This is the first study to establish the reliability of these tests by comparing the resuts with musculoskeletal ultrasound (US) findings. This study examined 125 patients (69 women and 56 men) and 143 shoulders with shoulder pain. Yergason's test, Speed's test and a bicipital groove tenderness test were performed and musculoskeletal US findings were used as standard reference. Biceps tendon tendinitis was diagnosed with US in 39.1% of the patients and, of those, 55.3% had coexisting rotator cuff injury. The sensitivity and specificity of Yergason's test were 32% and 78%, respectively. The sensitivity and specificity of Speed's test were 63% and 58%, respectively. In conclusion, all three tests are limited by poor sensitivity. US can be an image modality choice in diagnosing biceps pathology.
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Affiliation(s)
- Hung-Sheng Chen
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
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Ottenheijm RPG, Joore MA, Walenkamp GHIM, Weijers RE, Winkens B, Cals JWL, de Bie RA, Dinant GJ. The Maastricht Ultrasound Shoulder pain trial (MUST): ultrasound imaging as a diagnostic triage tool to improve management of patients with non-chronic shoulder pain in primary care. BMC Musculoskelet Disord 2011; 12:154. [PMID: 21740540 PMCID: PMC3141612 DOI: 10.1186/1471-2474-12-154] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 07/08/2011] [Indexed: 01/16/2023] Open
Abstract
Background Subacromial disorders are considered to be one of the most common pathologies affecting the shoulder. Optimal therapy for shoulder pain (SP) in primary care is yet unknown, since clinical history and physical examination do not provide decisive evidence as to the patho-anatomical origin of the symptoms. Optimal decision strategies can be furthered by applying ultrasound imaging (US), an accurate method in diagnosing SP, demonstrating a clear relationship between diagnosis and available therapies. Yet, the clinical cost-effectiveness of applying US in the management of SP in primary care has not been studied. The aim of this paper is to describe the design and methods of a trial assessing the cost-effectiveness of ultrasound imaging as a diagnostic triage tool to improve management of primary care patients with non-chronic shoulder pain. Methods/Design This randomised controlled trial (RCT) will involve 226 adult patients with suspected subacromial disorders recruited by general practitioners. During a Qualification period of two weeks, patients receive care as usual as advised by the Dutch College of General Practitioners, and patients are referred for US. Patients with insufficient improvement qualify for the RCT. These patients are then randomly assigned to the intervention or the control group. The therapies used in both groups are the same (corticosteroid injections, referral to a physiotherapist or orthopedic surgeon) except that therapies used in the intervention group will be tailored based on the US results. Ultrasound diagnosed disorders include tendinopathy, calcific tendinitis, partial and full thickness tears, and subacromial bursitis. The primary outcome is patient-perceived recovery at 52 weeks, using the Global Perceived Effect questionnaire. Secondary outcomes are disease specific and generic quality of life, cost-effectiveness, and the adherence to the initial applied treatment. Outcome measures will be assessed at baseline, 13, 26, 39 and 52 weeks after inclusion. An economic evaluation will be performed from both a health care and societal perspective with a time horizon of 52 weeks. Discussion The results of this trial will give unique evidence regarding the cost-effectiveness of US as a diagnostic triage tool in the management of SP in primary care.
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Affiliation(s)
- Ramon P G Ottenheijm
- Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, and Department of Orthopaedic Surgery, Maastricht University Hospital, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Smith TO, Back T, Toms AP, Hing CB. Diagnostic accuracy of ultrasound for rotator cuff tears in adults: a systematic review and meta-analysis. Clin Radiol 2011; 66:1036-48. [PMID: 21737069 DOI: 10.1016/j.crad.2011.05.007] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 05/04/2011] [Accepted: 05/14/2011] [Indexed: 02/06/2023]
Abstract
AIM To determine the diagnostic accuracy of ultrasound to detect partial and complete thickness rotator cuff tears based on all available clinical trials. MATERIALS AND METHODS An electronic search of databases registering published and unpublished literature was conducted. All diagnostic accuracy studies that directly compared the accuracy of ultrasound (the index test) to either arthroscopic or open surgical findings (the reference test) for rotator cuff tear were included. The methodological quality of each included study was assessed using the QUADAS form. When appropriate, pooled sensitivity and specificity analysis was conducted, with an assessment of the summary receiver operating characteristic (ROC) curve for each analysis. RESULTS Sixty-two studies assessing 6007 patients and 6066 shoulders were included. Ultrasonography had good sensitivity and specificity for the assessment of partial thickness (sensitivity 0.84; specificity 0.89), and full-thickness rotator cuff tears (sensitivity 0.96; specificity 0.93). However, the literature poorly described population characteristics, assessor blinding, and was based on limited sample sizes. The literature assessing transducer frequency was particularly small in size. CONCLUSION Ultrasonography is an appropriate radiological technique for the assessment of rotator cuff tears with an acceptable sensitivity and specificity. The diagnostic test accuracy of ultrasound is superior for the detection of full-thickness compared to partial-thickness cuff tears. Further study assessing the effect of transducer frequency is warranted.
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Affiliation(s)
- T O Smith
- Department of Physiotherapy, University of East Anglia, Norwich, UK.
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Abstract
Although the incidence of partial-thickness rotator cuff tears (PTRCTs) was reported to be from 13% to 32% in cadaveric studies, the actual incidence is not yet known. The causes of PTRCTs can be explained by either extrinsic or intrinsic theories. Studies suggest that intrinsic degeneration within the rotator cuff is the principal factor in the pathogenesis of rotator cuff tears. Extrinsic causes include subacromial impingement, acute traumatic events, and repetitive microtrauma. However, acromially initiated rotator cuff pathology does not occur and extrinsic impingement does not cause pathology on the articular side of the tendon. An arthroscopic classification system has been developed based on the location and depth of the tear. These include the articular, bursal, and intratendinous areas. Both ultrasound and magnetic resonance image are reported with a high accuracy of 87%. Conservative treatment, such as subacromial or intra-articular injections and suprascapular nerve block with or without block of the articular branches of the circumflex nerve, should be considered prior to operative treatment for PTRCTs.
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Affiliation(s)
- Keun Man Shin
- Department of Anesthesiology and Pain Medicine, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
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