Article Text

FRI0475 Radiologists against rheumatologists on technical aspects of shoulder ultrasound: from the disagreement to final consensus
  1. A. Adinolfi1,
  2. G. Filippou1,
  3. A. Delle Sedie2,
  4. E. Filippucci3,
  5. A. Iagnocco4,
  6. F. Porta5,
  7. L. M. Sconfienza6,
  8. S. Tormenta7,
  9. B. Frediani1
  1. 1Rheumatology Unit, University of Siena, Siena
  2. 2Rheumatology Unit, University of Pisa, Pisa
  3. 3Clinica Reumatologica, Università Politecnica delle Marche, Jesi-Ancona
  4. 4Rheumatology Department, Università Sapienza, Rome
  5. 5Rheumatology Unit, University of Florence, Florence
  6. 6Unit of Radiology, IRCCS POliclinico San Donato, San Donato Milanese, Milano
  7. 7Department of Diagnostic Imaging, S. Pietro Fatebenefratelli, Rome, Italy


Background Shoulder pain is a common condition in rheumatologist’s practice. Ultrasound (US) gained a central role in diagnosis of painful shoulder. However, in literature there aren’t guidelines on how to report shoulder US examination and it is plausible that radiologists and rheumatologists could describe the same findings in different ways, due to different cultural background

Objectives To compare US technique and reports of shoulder examination performed by radiologists and rheumatologists, to identify the main discrepancies and resolve them.

Methods Five rheumatologists and 2 radiologists, experienced in US, participated. The study was divided in 2 phases, in the first one each participant performed an US of 3 patients (one shoulder each) and reported the findings, blinded to the patients diagnosis and to the other operators technique and findings. US technique of each operator was observed and reported by other 3 doctors. Subsequently, the reports along with the images were compared to identify the main discrepancies and to propose solutions in order to uniform both technical aspects and reporting of the findings. In the second phase a US exam of a fourth patient was performed in plenary, to assess feasibility and efficacy of the “common approach” as defined previously.

Results The US scanning technique adopted was similar for all operators, differing only for the sequence of the scans. During the exam, rheumatologists paid more attention on US findings suggestive of inflammatory disease, while radiologists were more interested in rotator cuff pathology, in line with the ESSR recommendations for US shoulder (1). The main differences in reporting emerged in description of rotator cuff pathology. Radiologists are more imprinted in a detailed description of lesions (measurements in 2 axis and scoring of lesions according to the feedback obtained by the interaction with orthopedists), whereas rheumatologists provided a careful description of inflammatory changes to distinguish between acute and chronic disorders. Experts concluded that both approaches are important and lesions should be measured in 2 axes and grade of degeneration, concomitant disorders and the age of lesion should be reported. Another major difference emerged in the description of the “irregularities” of bone surface. Experts concluded that the irregularities should not be reported as “erosions” because such term could evocate an inflammatory joint disease (i.e rheumatoid arthritis) when it is known that the irregularities of the cortex can be found in other conditions (osteoarthritis of the shoulder). The term erosion should be used only when an inflammatory joint disease is strongly suspected. Other minor points that have been discussed and addressed will be presented in the extended work.

Conclusions This study allowed to clarify some points of divergence in US reporting and represented an interesting experience of collaboration between radiologists and rheumatologists.


  1. Klauser AS, Tagliafico A, Allen GM et al. Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology Eur Radiol. 2012 May;22(5):1140-8. Epub 2012 Mar 28

Disclosure of Interest None Declared

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