Ultrasound of the shoulder

doi:10.1016/S0929-8266(01)00140-9

European Journal of Ultrasound

Volume 14, Issue 1, October 2001, Pages 3-9

https://doi.org/10.1016/S0929-8266(01)00140-9 Get rights and content

Abstract

Ultrasound of the shoulder is a powerful and accurate method for the examination of the rotator cuff, biceps mechanism and the synovium. This article describes the anatomy, standard examination technique, indications, pitfalls and potential errors. It lists suggested imaging algorithms for a range of shoulder pathology.

Section snippets

History

Shoulder ultrasound has been performed for approximately 20 years, with the first literature report in 1979 (Seltzer et al., 1979). Subsequently the technique has been developed to improve visualisation of the rotator cuff (Crass et al., 1984). However, the major advances have been technological. Substantial improvements in hardware have occurred especially in small parts high resolution probes. Initially poor results were reported for US in comparison to arthrography, but these studies are now

Anatomy

The rotator cuff includes four muscles.

The supraspinatus spans between the posterior aspect of the scapula, above the scapular spine (supraspinatus fossa) to insert on the upper facet of the greater tuberosity. The subacromial bursa separates it from the acromium, the deltoid and the coraco-acromial ligament.

Below this is the infraspinatus, which crosses from the infraspinous scapular fossa to the middle facet of the greater tuberosity. It is separated from the scapula by a bursa.

More inferior

Technique

The authors examine the shoulder from behind the patient, which in their view allows for an increased stability in scanning and therefore less hand fatigue for the operator (Middleton, 1992), but some sonographers would rather examine from the front of the patient. A technique for scanning with the patient supine and the arm hung down by the side has also been described (Turrin and Cappello, 1997). When examining the seated patient they should be on a backless stool at a height that is

Rotator cuff tears

The detection or exclusion of rotator cuff tears is the most common reason for using ultrasound to examine the shoulder and in experienced hands it can be relied upon to make surgical decisions (Wiener and Seitz, 1993). With the advent of arthroscopic rotator cuff repairs ultrasound has become an important means of detecting small tears, with small tears less than 5 mm (or arguably10 mm) being amenable to arthroscopic repair. It is agreed that in experienced hands the detection of such tears

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Cited by (41)

Development and evaluation of a novel flex sensor-based glenohumeral subluxation degree assessment for wearable shoulder sling
2022, Sensors and Actuators A: Physical
Glenohumeral subluxation (GHS) is reported in as many as 81% of patients with stroke. To ensure that the glenohumeral joint head is in the socket, an orthosis is required to automatically adjust the degree of orthosis according to the degree of GHS. However, there is currently no wearable method for assessing the degree of GHS. This study aims to develop a GHS assessment method for patients with stroke that has the potential to be integrated into a wearable shoulder sling. To that end, we developed a GHS assessment method for patients with stroke based on a flex sensor. Seventeen patients with stroke in a diverse degree of GHS were recruited for the study. The GHS degree of patients was assessed by the flex sensor and gold-standard radiographic assessment. The GHS degree measurement by flex sensor (AGHS) and radiographic assessment (AGTD) has strongly correlated ( $r = 0.92, p < 0.01$ ). The relationship of AGTD and AGHS is linear according to an interpolating curve with an equation: $AGTD = 1.091 AGHS - 0.702$ ( $R 2 = 0.84$ , $RMSE = 1.92$ mm). The method has excellent reliability with $R = 0.87$ , $CI = 95 %$ for assessment of GHS degrees. The proposed method demonstrates good performance, is wearable, easy to use, and allows automatic measurements, so as to be a valuable method to assessment of GHS.
Quantitative Evaluation of Rotator Cuff Tears Based on Non-linear Statistical Analysis of Ultrasound Radiofrequency Signals
2021, Ultrasound in Medicine and Biology
Citation Excerpt :
US is an alternative imaging method for dynamic and functional assessment of RCTs. Compared with MRI, US is less costly and has few contraindications for most patients (Allen and Wilson 2001; Vlychou et al. 2009; Kim et al. 2017; Chang et al. 2020; Chiu et al. 2020). It has been reported that the diagnostic accuracy of US is comparable to that of MRI for full-thickness RCTs (Teefey et al. 2000; Roberts et al. 2001; Miller et al. 2008), while it may be reduced in the diagnosis of partial-thickness RCTs because experience may differ between operators (Martin-Hervas et al. 2001; Teefey et al. 2004; Moosmayer et al. 2007; Vlychou et al. 2009; Sipola et al. 2010; Smith et al. 2011; Okoroha et al. 2019).
There is increasing clinical requirement for early and accurate ultrasound diagnosis of rotator cuff tears (RCTs). A method based on non-linear statistical analysis was proposed for the detection of RCTs using ultrasound radiofrequency (RF) signals. One hundred fifty-two patients with shoulder pain were first examined with ultrasound and then diagnosed with magnetic resonance imaging (MRI) as the ground truth. By comparison of the region of interest (ROI) with a part of the supraspinatus with no pathologic change part in the same RF signal frame, the relative P_ks value (viz., rP_ks value) was evaluated to quantify the pathophysiologic changes. The results indicated that the rP_ks values of all RCTs are <0.7, and the accuracy, sensitivity and specificity of the proposed method can reach 97.5%, 100% and 91.4%, respectively. This computer-aided method was found to perform better diagnostic than the results reported by an experienced radiologist (accuracy = 75.7%, sensitivity = 72.6%, and specificity = 85.7%). The high sensitivity advantage of this method indicates that the prospects for its application in the computer-aided diagnosis of RCTs are good.
Ultrasonographic Evaluation and Feasibility of Posterosuperior Internal Impingement Syndrome: A Case Series
2017, PM and R
Citation Excerpt :
The gold-standard test for deep shoulder structures such as the labrum, bone lesion, and ligamentous abnormalities is MRI, which can be expensive and inaccessible [5]. Interestingly, we found that US had advantages over MRI for PSI syndrome, although US for these peri-articular structures, including labrum and bony cyst, is generally limited [4-6]. First, MRI did not identify the rotator cuff partial-thickness tears in the posterior supraspinatus or upper infraspinatus areas as cardinal PSI lesions in patients 2 and 3.
Posterosuperior impingement (PSI) is an underdiagnosed cause of posterior shoulder pain and should be differentiated from classic and external impingement. PSI involves the internal impingement of soft tissues, including the undersurface of the rotator cuff against the posterosuperior labrum when the arm is brought into abduction and external rotation (ABER). Ultrasonography (US) can be useful in the assessment of PSI because of its high resolution and ability to perform during dynamic maneuvers in ABER. This series of 3 cases illustrates the feasibility of US in the evaluation of PSI when the history and physical examination implicate this condition.
V
Computer-Aided Diagnosis of Different Rotator Cuff Lesions Using Shoulder Musculoskeletal Ultrasound
2016, Ultrasound in Medicine and Biology
Citation Excerpt :
However, large foci of hard calcification appear as hyper-echoic convex contours with acoustic shadows (Beggs 2011). Supraspinatus tears are characterized by hypo-echoic areas with irregular margins (Allen and Wilson 2001; Kurol et al. 1991; Vlychou et al. 2009). According to tissue characteristics reported in prior studies, the morphologic features widely used in CAD systems may not be useful in lesion classification because there is no rule of shape description for a specific lesion type.
The lifetime prevalence of shoulder pain approaches 70%, which is mostly attributable to rotator cuff lesions such as inflammation, calcific tendinitis and tears. On clinical examination, shoulder ultrasound is recommended for the detection of lesions. However, there exists inter-operator variability in diagnostic accuracy because of differences in the experience and expertise of operators. In this study, a computer-aided diagnosis (CAD) system was developed to assist ultrasound operators in diagnosing rotator cuff lesions and to improve the practicality of ultrasound examination. The collected cases included 43 cases of inflammation, 30 cases of calcific tendinitis and 26 tears. For each case, the lesion area and texture features were extracted from the entire lesions and combined in a multinomial logistic regression classifier for lesion classification. The proposed CAD achieved an accuracy of 87.9%. The individual accuracy of this CAD system was 88.4% for inflammation, 83.3% for calcific tendinitis and 92.3% for tears. Cohen's k was 0.798. On the basis of its diagnostic performance, clinical use of this CAD technique has promise.
Accuracy of diagnostic ultrasound in patients with suspected subacromial disorders: A systematic review and meta-analysis
2010, Archives of Physical Medicine and Rehabilitation
Ottenheijm RP, Jansen MJ, Staal JB, van den Bruel A, Weijers RE, de Bie RA, Dinant G-J. Accuracy of diagnostic ultrasound in patients with suspected subacromial disorders: a systematic review and meta-analysis.
To determine the diagnostic accuracy of ultrasound for detecting subacromial disorders in patients presenting in primary and secondary care settings.
Medline and Embase were searched on June 9, 2010. In addition, the reference list of 1 systematic review and all included articles were searched to identify relevant studies.
Two reviewers independently selected the articles evaluating the accuracy of ultrasound for detecting subacromial disorders from the title and abstracts retrieved by the literature search. Selection criteria were ultrasound frequency greater than or equal to 7.5MHz as index test, surgery, magnetic resonance imaging and/or radiography as reference standards, and subacromial disorders as target conditions.
Two reviewers independently extracted the data on study characteristics and results to construct 2 by 2 tables and performed a methodologic quality assessment.
Twenty-three studies were included: 22 reported on full-thickness rotator cuff tears, 15 on partial-thickness tears, 3 on subacromial bursitis, 2 on tendinopathy, and 2 on calcifying tendonitis, respectively. For full-thickness tears, pooled sensitivity of ultrasound was .95 (95% confidence interval, .90–.97), and specificity .96 (.93–.98). For partial-thickness tears, pooled sensitivity was .72 (.58–.83), and specificity .93 (.89–.96). Statistical pooling was not possible for the other disorders. For subacromial bursitis, sensitivity ranged from .79 to .81, and specificity from .94 to .98. For tendinopathy, sensitivity ranged from .67 to .93, specificity from .88 to 1.00. Sensitivity for calcifying tendonitis was 1.00 in both studies, with specificity ranging from .85 to .98.
We strongly recommend ultrasound in patients for whom conservative treatment fails, to rule in or out full-thickness tears, to rule in partial-thickness tears, and to a lesser extent to diagnose tendinopathy, subacromial bursitis, and calcifying tendonitis. These results can help physicians tailor treatment.
Usefulness of Ultrasound in Osteoarthritis
2009, Rheumatic Disease Clinics of North America

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Ultrasound of the shoulder

Abstract

Section snippets

History

Anatomy

Technique

Rotator cuff tears

Radiologic Clinics of North America

Radiologic Clinics of North America

Sonographic evaluation of posterior instability and dislocation of the shoulder: prospective study

Journal of Ultrasound in Medicine

Ultrasound guided aspiration of symptomatic supraspinatus calcific deposits

British Journal of Radiology

Ultrasonography of the rotator cuff. Normal and pathologic anatomy

Investigative Radiology

Hill-Sachs lesion in recurrent shoulder dislocation: sonographic detection

Journal of Ultrasound in Medicine

The hyperextended internal rotation view in rotator cuff ultrasonography

Jcu. J. Clin. Ultrasound

Ultrasonography of rotator cuff tears: a review of 500 diagnostic studies

Jcu. J. Clin. Ultrasound

Ultrasonography of the rotator cuff: surgical correlation

Jcu. J. Clin. Ultrasound

Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms

Annals of the Rheumatic Diseases

Sonography of the biceps tendon of the shoulder: normal and pathologic findings

Journal of Clinical Ultrasound

Rotator cuff calcifications: treatment with US-guided technique

Radiology

Rotator cuff calcifications: treatment with ultrasound-guided percutaneous needle aspiration and lavage

Skeletal Radiology