• ultrasonography
• shoulder

Painful shoulder is a very common condition in clinical rheumatology. However, knowledge of the lesions responsible for shoulder pain in most patients has been limited to clinical examination and plain radiography in clinical practice. High frequency ultrasonography is an accurate,^1–4 non-invasive, and cheap imaging technique available in clinical rheumatology for evaluating patients with painful shoulder. However, dependence on the skill of the operator has been considered to be the main disadvantage of ultrasound. Diagnostic results are affected by the quality of the equipment, examination technique, sonographer experience, and sonographic diagnostic criteria.

We compared the ultrasonographic findings in two groups of patients with clinically diagnosed periarticular disorders, with a first flare of shoulder pain—group I: 228 patients (228 shoulders); group II: 110 patients (122 shoulders). Patients with previous trauma or chronic inflammatory arthritis were excluded.

Each group was examined in Italy or in Spain by a different rheumatologist (AI, Rome, Italy and EN, Madrid, Spain) using a different commercially available real time machine (Image Point Hx, Agilent Technologies/HP and Sonoline, Versa, Siemens, Seattle, USA, respectively) with a 7.5 MHz linear phased array transducer. Both rheumatologists used the same scanning technique and the same sonographic diagnostic criteria for shoulder lesions.^5,6 A χ² test was used to compare quantitative variables. A value of p<0.05 was considered significant.

Group I comprised 132 women and 96 men with a mean age of 45.6 years (range 18–64). The mean duration of symptoms was 3.3 months (range 1–8). Group II comprised 81 women and 29 men with a mean age of 54.5 years (range 25–75). The mean duration of symptoms was 8.6 months (range 0.5–36).

The sonographic pathologic findings in the painful shoulders were similar for both groups (p>0.05) (table 1). In most patients various different periarticular structures were affected. Supraspinatus tendon lesions were the most common pathological finding (fig 1). Infraspinatus and subscapularis abnormalities were seen less often. Increased fluid within the subacromial-subdeltoid bursa and biceps tendon sheath were also very common, as were degenerative changes in the acromioclavicular joint.

Our results are consistent with those previously reported.^7–10 Ultrasound provides a valuable method for studying painful shoulders in daily practice and clinical research. The scanning technique and pathological criteria should be standardised to achieve optimum widespread use of ultrasonography in rheumatology.

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Figure 1

Sonographic imaging of a supraspinatus tear. Transverse sonogram. Note the presence of fluid (F) filling the defect of the supraspinatus tendon (SS). DM, deltoid muscle; HH, humeral head.