Accuracy of High Resolution Sonographic Evaluation of Painful Shoulder

Painful shoulder is a very common condition that results from periarticular lesions involving the rotator cuff, the biceps tendon, and the subacromio-subdeltoid bursa. Ultrasonography [1] (USG) has advantage of offering a dynamic examination enabling an assessment of both the range of movement and muscular coordination.

Imaging Protocol and Correlation: All fifty patients (25 males and 25 females; range 26-67 years; mean symptoms duration 2.4 months) with symptomatic shoulder as case and asymptomatic shoulder as control were subjected to detailed clinical history, physical examination and sonographic study.

Results: Most rotator cuff lesions involved the “critical zone” (an area of relative avascularity 1 cm proximal to the point of insertion on the greater tuberosity) in the anterior aspect of tendons. Supraspinatus tendon most commonly showed abnormality on ultrasound (26%). Subscapularis (4%) and infraspinatus (4%) were the next common tendons to show abnormality. Teres minor was normal in all the patients. Partial thickness tears of supraspinatus tendon were more common than full thickness tears in the present study. Articular surface partial-thickness tear was most common type of partial-thickness tear in our study.

Conclusion: We can conclude that sonography is an attractive screening modality for the rotator cuff in patients with painful shoulder. In nut shell, a well performed ultrasound examination in most cases obviates the need for the more invasive arthrography and the more cumbersome and expensive MRI examination. Based on these results it appears that ultrasonography can be used as the initial imaging test for many patients with suspected abnormalities of the rotator cuff or biceps tendon.