Evaluation of Diagnostic Precision of Ultrasound for Rotator Cuff Disorders in Patients with Shoulder Pain

Document Type : RESEARCH PAPER

Authors

1 Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: Rotator cuff disorders are a leading cause of shoulder symptoms. Accurate imaging, detecting the type
of the involved muscle, and severity of the injury have important effects on the choice of treatment. Accordingly, the
current study was conducted to evaluate the diagnostic accuracy of ultrasound for rotator cuff disorders in patients
suffering from shoulder pain and to explore the precision of ultrasound in determining the exact dimensions of a tear in
comparison with magnetic resonance imaging (MRI).
Methods: This prospective research was performed on patients clinically suspected of rotator cuff tendinopathy. An
ultrasound of the shoulder was initially performed for the candidates. In this study, MRI was regarded as the modality
of choice for examining the images of shoulder disorders. The European Society of Musculoskeletal Radiology (ESSR)
guidelines were used to design the protocols and implement imaging measures. Based on the reference standard of
MRI, the specificity and sensitivity as well as positive and negative predictive values of ultrasound in detection of rotator
cuff disorders were calculated.
Results: A total of48 patients (22 women, 23 dominant right hands) with an average age of 51.6±8.3 years were
enrolled in this study. Based on MRI findings, rotator cuff disorders were detected in 43 patients (89.5%). The most
commonly observed disorders were partial-thickness rotator cuff tear (n=17, 35.4%), full-thickness rotator cuff tear
(n=16, 33.3%), and tendinopathy (n=10, 20.8%). Among rotator cuff disorders, the highest sensitivity of ultrasound was
observed in the detection of full-thickness tear (93.7%) and rotator cuff tendinopathy (90%). The highest specificity was
found in the detection of full-thickness rotator cuff tear (100%) and partial-thickness rotator cuff tear (96.7%).
Conclusion: Based on our findings, ultrasound could be considered as a high-quality diagnostic tool to rule in partial
and full-thickness rotator cuff tears and rule out the rotator cuff pathologies.
Level of evidence: I

Keywords


1. 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(1):e124-30.
2. Gomoll AH, Katz JN, Warner JJ, Millett PJ. Rotator
cuff disorders: recognition and management among
patients with shoulder pain. Arthritis & rheumatism.
2004;50(12):3751-61.
3. Lee SC, Williams D, Endo Y. The repaired rotator cuff:
MRI and ultrasound evaluation. Current reviews in
musculoskeletal medicine. 2018;11(1):92-101.
4. Lin A, Gasbarro G, Sakr M. Clinical applications of
ultrasonography in the shoulder and elbow. JAAOSJournal
of the American Academy of Orthopaedic
Surgeons. 2018;26(9):303-12.
5. Singson RD, Hoang T, Dan S, Friedman M. MR
evaluation of rotator cuff pathology using T2-weighted
fast spin-echo technique with and without fat
suppression. AJR. American journal of roentgenology.
1996;166(5):1061-5.
6. De Jesus JO, Parker L, Frangos AJ, Nazarian LN.
Accuracy of MRI, MR arthrography, and ultrasound
in the diagnosis of rotator cuff tears: a metaanalysis.
American Journal of Roentgenology.
2009;192(6):1701-7.
7. Fotiadou AN, Vlychou M, Papadopoulos P, Karataglis
DS, Palladas P, Fezoulidis IV. Ultrasonography of
symptomatic rotator cuff tears compared with MR
imaging and surgery. European journal of radiology.
2008;68(1):174-9.
8. Chiu CH, Chen P, Chen AC, Hsu KY, Chang SS, Chan
YS, et al. Shoulder ultrasonography performed by
orthopedic surgeons increases efficiency in diagnosis
of rotator cuff tears. Journal of Orthopaedic Surgery
and Research. 2017;12(1):1-0.
9. Li X, Paul HY, Curry EJ, Murakami AM.
Ultrasonography as a diagnostic, therapeutic, and
research tool in Orthopaedic surgery. JAAOS-Journal
of the American Academy of Orthopaedic Surgeons.
2018;26(6):187-96.
10. 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. Journal of orthopaedics.
2015;12(1):23-30.
11. Martinoli C. Musculoskeletal ultrasound: technical
guidelines. Insights into imaging. 2010;1(3):99-141.
12. Rutten MJ, Jager GJ, Blickman JG. US of the rotator
cuff: pitfalls, limitations, and artifacts. Radiographics.
2006;26(2):589-604.
13. Narasimhan R, Shamse K, Nash C, Dhingra D, Kennedy
S. Prevalence of subscapularis tears and accuracy
of shoulder ultrasound in pre-operative diagnosis.
International orthopaedics. 2016;40(5):975-9.
14. Gharib M, Mardanipour K, Rezaei M, Moradi N.
Comparision of diagnostic accuracy of ultrasonography
versus MRI in the detection of rotator cuff tears.
Kurdistan J Med Sci. 2014; 19(1):108-13.
15. Roy JS, Braën C, Leblond J, Desmeules F, Dionne
CE, MacDermid JC, et al. Diagnostic accuracy of
ultrasonography, MRI and MR arthrography in the
characterisation of rotator cuff disorders: a systematic
review and meta-analysis. British journal of sports
medicine. 2015;49(20):1316-28.
16. Teng A, Liu F, Zhou D, He T, Chevalier Y, Klar RM.
Effectiveness of 3-dimensional shoulder ultrasound
in the diagnosis of rotator cuff tears: a meta-analysis.
Medicine. 2018;97(37).
17. Co S, Bhalla S, Rowan K, Aippersbach S, Bicknell
S. Comparison of 2-and 3-dimensional shoulder
ultrasound to magnetic resonance imaging in a
community hospital for the detection of supraspinatus
rotator cuff tears with improved worktime room
efficiency. Canadian Association of Radiologists
Journal. 2012;63(3):170-6.
18. Jung JY, Jee WH, Park MY, Lee SY, Kim YS. Supraspinatus
tendon tears at 3.0 T shoulder MR arthrography:
diagnosis with 3D isotropic turbo spin-echo SPACE
sequence versus 2D conventional sequences. Skeletal
radiology. 2012;41(11):1401-10.
19. Pattee GA, Snyder SJ. Sonographic evaluation of
the rotator cuff: correlation with arthroscopy.
Arthroscopy: The Journal of Arthroscopic & Related
Surgery. 1988;4(1):15-20.
20. Vlychou M, Dailiana Z, Fotiadou A, Papanagiotou M,
Fezoulidis IV, Malizos K. Symptomatic partial rotator
cuff tears: diagnostic performance of ultrasound and
magnetic resonance imaging with surgical correlation.
Acta radiologica. 2009;50(1):101-5.
21. Tse AK, Lam PH, Walton JR, Hackett L, Murrell
GA. Ultrasound determination of rotator cuff tear
repairability. Shoulder & elbow. 2016;8(1):14-21.