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AB0665 Relationship between clinical and ultrasonographic changes in patients with shoulder pain
  1. A.-M.-M. Ramazan1,
  2. S. Albina2,
  3. M. Suta3
  1. 1Rheumatology, Emergency Clinical County Hospital, Constanta
  2. 2Rehabilitation Clinic, Rehabilitation Clinical Hospital, Eforie Nord
  3. 3Internal Medicine, Ovidius University, Constanta, Romania


Background The shoulder is one of the most common application of musculoskeletal ultrasound due to the high incidence of rotator cuff disorders related to increasing aging and sporting activities (1) Muskuloskeletal ultrasound has demonstrated a number of diagnostic and therapeutic techniques applicable to pathology of shoulder, especially rotator cuff and tendinopathies (tenosynovitis, tendinosis, partial and complete tear, and impingement) (2,3,4). Moreover, most patients with shoulder pain prefer sonography to MRI (5).

Objectives To investigate the relationship between clinical examination and ultrasonographic changes in patients with shoulder pain

Methods We had examined 21 hospitalised patients with shoulder pain in our clinic between November and December 2012, with a median age 60 ± 10.56 years, 75% were female. The assessment had included a medical history, a clinical assessment (classical testing with maneuvers empty-can, Neer, Hawkins, Speed, Yergasson) and a ultrasonographic assessment in grey scale with static and dynamic examination. The followed ultrasonographic were tendinitis (supraspinatus, subscapularis, infraspinatus, terres minor), bicipital tenosynovitis, subacromial bursitis, impingement syndrome of supraspinatus and subscapularis tendons, and tears of supraspinatus, subscapularis, infraspinatus and biceps.

Results We had found tendinitis (supraspinatus-52.4%, infraspinatus-4.8%, terres minor–4.8%, subscapularis-23.8%), impingement syndrome(61.9%), bicipital tenosinovitis (28.6%), subacromial bursitis (38.1%), tear of tendons (23.8%), bicipital instability (4.8%) and dislocation (14.3%). After a complex analysis we had noticed that persistent pain over 6 months correlated only with impingement syndrome of subscapularis tendon (p=0.071), nocturnal pain was present in 60% of patients with subscapularis tendinitis (p=0048), but continous pain and acute onset did not correlated with ultrasonographic changes (p=NS). About testing, empty-can test was positive in all patients whatever ultrasonographic changes; the Neer and Hawkins tests were positive with statistical significance in all patients with supraspinatus tendinitis (p=0.004, p=0.035 respectivelly); Speed and Yergasson tests did correlate to any ultrasonographic changes (p=NS). The Neer test was positive in supraspinatus tear only in a minority of patients (25%) (p=0.05).

Conclusions The shoulder ultrasonography is highly useful to complete clinical examination, which is indicative and nonspecific.

  1. Bianchi S, Martinoli C, Ultrasound of the Musculoskeletal System, 2007, Springer edditon

  2. Yim ES, Corrado G, Ultrasound in sport medicine: relevance of emerging techniques to clinical care of athletes, Sports Med 2012, 42: 665-80

  3. Petranova T et al, Ultrasound of the shoulder, Med Ultrason 2012, 14: 133-40

  4. Levine BD et al, Imaging of the shoulder: a comparison of MRI and ultrasound, Curr Sports Med Rep 2012, 11: 239-43

  5. Middleton WD et al, Sonography and MRI of the shoulder: comparison of patient satisfaction, AJR Am J Roentgenol. 2004;183(5):1449-52

Disclosure of Interest None Declared

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