Background Ultrasonographic features in shoulder pain have been extensively described in many series. Most epidemiological studies have focused on ultrasonographic findings without considering time of onset of symptoms. In our experience with patients with shoulder pain of recent onset (less than a week) we find ultrasonographic features which proportions are discordant with global epidemiological data especially in terms of prevalence of subacromial bursitis and supraspinatus tendinosis.
Objectives To describe and compare ultrasonographic findings on patients with shoulder pain who consulted to our emergency department and underwent an ultrasonographic shoulder assessment.
Methods The registries of the musculoskeletal and rheumatologic urgencies unit of our A&E department, from 2013 to 2015 were consulted. The known ratio of ultrasonographic assessment of our unit is close to 95% of all shoulder pain cases. Two rheumatologists with full ultrasonographic training and at least 3 years of experience performed the studies following Eular shoulder ultrasonographic definitions. Findings were grouped according to time of onset of symptoms using an arbitrary definition of hyperacute (<7 days), acute (1 to 6 weeks) and chronic (>6 weeks) of shoulder pain.
Results 474 registries of shoulder ultrasonographic assessments were reviewed. Average age of patients was 59 SD 17 years old. Male proportion was 67%. Global findings showed that supraspinatus tendon was affected in 86.7% of all records, while subscapularis tendon in 26.8% and biceps tendon in 11.8%. 67, 47 and 20 registries were classified as hyperacute, acute and chronic shoulder pain, respectively. 38.6% of all supraspinatus tendinosis was present in hyperacute, 25.1% in acute and 36.3% in chronic shoulder pain. 50% of all subacromial bursitis detected were present in hyperacute shoulders, 35.1% in acute and 14.9% in chronic shoulder pain. 34.2% of all supraspinatus tears were present in hyperacute shoulders, 47.4% in acute and 18.4% in chronic shoulder pain. 70% of all subscapularis tendinosis were present in hyperacute and 30% in acute shoulders. 12.7% of all subscapularis calcifications were present in hyperacute shoulders, 31.7% in acute and 55.6% in chronic shoulders. All of these distributions had differences statistically significant. Supraspinatus calcification distribution was not statistically different in the three groups.
Conclusions Subacromial bursitis and subscapularis tendinosis seems to be the most frequent finding in patients with hyperacute shoulder pain. Our results, in patients with less than a week of symptoms, do not agree with most epidemiological ultrasonographic studies of the shoulder. It is possible that differences could be explained by the fact that most studies have not been performed in patients with hyperacute shoulder pain. In our opinion, a better comprehension of shoulder ultrasonographic features in shoulder pain should be linked to the time of onset of symptoms.
Disclosure of Interest None declared