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

OBJECTIVE: To analyze the results of ultrasound (US)-guided needle puncture, aspiration and lavage in the treatment of symptomatic calcific tendinitis of the rotator cuff. DESIGN AND PATIENTS: Atraumatic pain in 61 shoulders of 58 patients was resistant to conservative therapy. The average age of the treated patients was 42 years (range 26-49 years), follow-up was 12 months, and the mean diameter of the calcifications was 1.6 cm (range 1.1-2.9 cm). With US guidance and local anesthesia, two needles were placed within each calcification. The calcification was punctured 10-15 times and saline solution injected and aspirated using the needles until the aspirate was free of calcific particles. RESULTS AND CONCLUSIONS: Based on radiographs at 1 year follow-up. 74% (45 of 61) of the calcifications decreased, including 28% (17 of 61) which disappeared totally, and 26% (16 of 61) were unchanged. Calcifications with a faint or absent shadow on US proved to be nearly liquid (slurry calcification in 93% (14 of 15) of cases and could be aspirated. Clinical results were excellent in 74% (45 of 61), moderate in 16% (10 of 61) and poor in 10% (6 of 61) of cases. US offers technical advantages over fluoroscopy, and the typical US image of a slurry calcification helps to select the most suitable patients for aspiration treatment. The results are comparable with those using fluoroscopic guidance.

Hill-Sachs lesion: sonographic detection.

OBJECTIVE: To determine the value of ultrasonography (US) in the detection of Hill-Sachs lesion of the humerus in comparison with double-contrast computed tomographic arthrography (CTA) and with arthroscopy. DESIGN AND PATIENTS: US and CTA were performed on 92 patients, 86 of whom subsequently underwent arthroscopy. The findings of US, CTA and arthroscopy in these 86 patients in the diagnosis of Hill-Sachs lesion were analyzed. RESULTS AND CONCLUSIONS: In the detection of Hill-Sachs lesion US showed a sensitivity of 91% (21 of 23), a specificity of 95% (60 of 63) and an accuracy of 94% (81 of 86) when compared with CTA, and a sensitivity of 94% (18 of 19), specificity of 91% (61 of 67) and accuracy of 91% (79 of 86) when compared with arthroscopy. In only 2% (2 of 86) of patients was there reduced visualization because of restriction of movement. Hill-Sachs lesion and its relationship to the humeral head can be reliably diagnosed with US.

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

Abnormalities of the tendon of the long head of the biceps brachii muscle commonly associate with other lesions about the shoulder, especially rotator cuff rupture, and are a frequent cause of a painful shoulder. As pathognomonic clinical signs of these lesions are often lacking, noninvasive imaging techniques are practical and valuable. In this report the anatomy of this tendon is described, correlating with sonographic images. Examination technique and typical sonographic findings in pathologic conditions affecting the long bicipital tendon sheath, the substance of the tendon, and the position of the tendon are illustrated. Their distinction is important to proper patient management.

Site and size of rotator-cuff tear. Findings at ultrasound, double-contrast arthrography, and computed tomography arthrography with surgical correlation.

RATIONALE AND OBJECTIVES: The authors discuss findings of ultrasound (US), double-contrast arthrography (AG), and contrast computed tomography arthrography (CTA) in assessing precise site and size of rotator-cuff tears. METHODS: Eighty-six patients were compared prospectively in a masked fashion; the results of surgery were studied in 25 patients and the results of arthroscopy were studied in 61 patients. RESULTS: Ultrasound detected 80% (8 of 10) of the partial-thickness tears and 90% (18 of 20) of the full-thickness tears. Arthrography and CTA had identical results with 70% sensitivity (7 of 10) in partial-thickness tears; AG showed 90% (18 of 20) and CTA 95% (19 of 20) of the full-thickness tears. Arthrography had two false-positive findings, and US and CTA had one each. The size of a tear could be evaluated correctly with AG in 30% (9 of 30), with US in 70% (21 of 30) and with CTA in 76% (23 of 30). More extensive tears were encountered at US than had been found at surgery in 2% (2 of 86) and less extensive tears in 9% (8 of 86); CTA depicted more extensive tears in 2% (2 of 86) and less extensive tears in 6% (6 of 86), respectively. The site of a tear could be evaluated with AG in 30% (9 of 30); US and CTA showed the site correctly in every patient in which the tear could be diagnosed. CONCLUSION: Ultrasound and CTA were equally accurate in diagnosing and evaluating the size and site of rotator-cuff tears. Double-contrast AG was less accurate in the diagnosis of tears and the size and site of tears clearly could be assessed worse.

Consistency of rotator-cuff calcifications. Observations on plain radiography, sonography, computed tomography, and at needle treatment.

RATIONALE AND OBJECTIVES: The author analyzes findings of consistency of rotator-cuff calcifications found at ultrasound (US)-guided needle treatment compared with findings of plain radiography, US, and computed tomography (CT). METHODS: Twenty patients had rotator-cuff calcifications (mean diameter, 1.5 cm; range, 1.1-2.6 cm) resistant to conservative therapy. At needle treatments, the consistency was assessed as hard or soft (slurry calcific deposit). In each imaging examination, the calcifications were divided into two groups. In radiographs, calcifications were divided into "well-defined" and "ill-defined." In US, they were divided into calcifications with acoustic shadow and calcifications with a faint shadow or no shadow. On CT, they were divided into homogeneous or nonhomogeneous calcifications. At CT, the density of the calcifications also was determined. The findings of consistency obtained at needle treatments were compared with the findings of plain radiography, US, and CT. RESULTS: At needle treatments, 45% (9 of 20) of the calcifications were soft or nearly liquid, and 55% (11 of 20) were hard. On plain radiographs, 67% (6 of 9) were as soft and 64% (7 of 11) as hard. On sonograms, 77% (7 of 9) were soft and 82% (9 of 11) were hard. On CT images, 77% (7 of 9) were soft and 91% (10 of 11) were hard; CT attenuation values were 77% (7 of 9) and 91% (10 of 11), respectively. CONCLUSIONS: Ultrasound and CT were reliable in predicting the consistency of rotator-cuff calcifications. Computed tomography attenuation values were the most accurate, and plain radiographs were the least accurate.

The bicipital groove of the humerus: sonographic and radiographic correlation.

OBJECTIVE: The objective of this study was to compare ultrasonography (US) and plain radiography in the evaluation of the bicipital groove of the humerus and to determine the accuracy of US in measurement of the width and depth of the groove compared to plain radiography. PATIENTS AND METHODS: Visualization of the groove and its abnormalities in 350 consecutive patients by US and on tangential groove radiographs were compared. The groove was measured prospectively in 45 patients on the ultrasound imaging monitor and retrospectively on groove radiographs without knowledge of the US results. RESULTS: The bony anatomy of the groove was adequately seen with US in 90% of patients (314 of 350) and on groove radiographs in 91% (319 of 350). All 24 shallow and 6 tunnel-shaped grooves were diagnosed with both imaging methods, but osteophytes and erosions could not be reliably demonstrated with US. CONCLUSION: Sonography was as accurate for evaluation of the dimensions of the bicipital groove as groove radiographs, and both methods had a similar failure rate. Pathological changes of the walls of the groove could not be reliably evaluated with sonography.

Acute traumatic tears of the rotator cuff: value of sonography.

PURPOSE: To determine the value of sonography in the evaluation of acute traumatic tears of the rotator cuff. MATERIALS AND METHODS: Preoperative sonography was performed within 3 weeks of trauma in 184 patients, 98 of whom underwent surgery. The rotator cuff tears were preoperatively classified as partial-thickness tears or as small, large, or massive full-thickness tears. Sonographic findings were correlated with surgical findings (n = 70) and arthroscopic inspection (n = 28). RESULTS: Adequate examination was possible in 163 (88%) of 184 patients. Sonography demonstrated 42 (91%) of 46 full-thickness tears and seven (78%) of nine partial-thickness tears. Sonography showed more extensive tears than were found at surgery in four (4%) of 98 patients and less extensive tears in seven (7%) of 98 patients. Sonographic patterns were a defect (31 [63%] of 49 tears), focal thinning (10 [21%] of 49 tears), and nonvisualization (eight [16%] of 49 tears). CONCLUSION: Sonography is useful in the evaluation of acute shoulder trauma when a rotator cuff tear is suspected and findings at plain radiography are negative.

Digital subtraction shoulder arthrography in determining site and size of rotator cuff tear.

RATIONALE AND OBJECTIVES: To evaluate the value of digital subtraction arthrographic techniques in assessing the precise size and site of rotator cuff tear. PATIENTS AND METHODS: Prospectively interpreted findings of 29 digital arthrographs were compared with results after surgery in 22 patients and with results after arthroscopy in 7 patients. RESULTS: Surgery or arthroscopy revealed 14 full-thickness and 2 partial-thickness tears. Digital subtraction arthrography showed 88% (14 of 16) of the rotator cuff tears, 86% (12 of 14) of the full-thickness tears, and 100% (2 of 2) of the partial-thickness tears. The site of a tear could be shown in 86% (12 of 14), but the size was evaluated to be less extensive than that seen at surgery in most tears (63%, 10 of 16). CONCLUSIONS: The site of tears could be demonstrated in supraspinatus tendon tears, but measurements of the size of the tears were accurate only in small full-thickness and in partial-thickness tears. Very anterior and posterior tears may not be diagnosed with this method, and postexercise films were necessary to avoid false-negative findings.

Rotator cuff calcifications: treatment with US-guided technique.

PURPOSE: The authors developed and tested a technique to treat calcific tendinitis in the rotator cuff with multiple needle punctures, aspiration, and lavage under ultrasonographic (US) guidance. MATERIALS AND METHODS: Atraumatic pain in the shoulders of a 46-year-old woman and a 42-year-old man was resistant to conservative therapy. With local anesthesia and continuous three-dimensional US visualization, the tips of two 18-gauge needles were placed within the calcification in the rotator cuff. Saline solution was injected and aspirated with the needles until the aspirate was free of calcific particles. RESULTS: Both patients experienced complete relief of pain and recovery of full range of motion, one on the 3rd day after treatment and one within 15 minutes. CONCLUSION: Use of this US-guided technique is successful to treat calcific tendinitis in the rotator cuff without the radiation exposure of fluoroscopic guidance.

Medial displacement of the biceps brachii tendon: evaluation with dynamic sonography during maximal external shoulder rotation.

PURPOSE: To determine the value of the sonographic subluxation test--dynamic scanning of a shoulder during maximal external rotation--in the evaluation of medial displacement of the biceps tendon. MATERIALS AND METHODS: The subluxation test was performed during shoulder sonography in 1,210 patients, 284 of whom subsequently underwent surgery (152 men and 132 women aged 24-77 years [mean, 52 years]). Subluxation or displacement of the biceps tendon was surgically confirmed in 21 of the 284 patients (16 men and five women aged 35-57 years [mean, 48 years]). The sonographic and surgical findings in these 21 patients were analyzed. RESULTS: The subluxation test helped detect 12 of 14 (86%) cases of subluxation. Static scanning (without the subluxation test) depicted six of seven (86%) cases of dislocation. The test failed or could not be performed in 18 of the 284 (6%) patients; however, no false-positive findings occurred. CONCLUSION: The subluxation test is reliable in the diagnosis of subluxation of the biceps tendon and should be performed during shoulder sonography.

Sonographic findings of rotator cuff calcifications.

We studied the findings and value of sonography in the diagnosis of rotator cuff calcifications in comparison to plain radiographs. Sonograms were correlated with plain radiographs in 951 patients. The diagnosis of rotator cuff calcifications was made by ultrasonography in 87 and with plain films in 93 of 951 patients. Sonography displayed two additional bursal slurry calcifications were found on plain films. Three types of calcifications were found with ultrasonography: (1) a hyperechoic focus with a well-defined shadow (79%); (2) a hyperechoic focus with a faint shadow (14%); and, (3) a hyperechoic focus with no shadow (7%). Large and slurry calcifications and bursal calcifications were better seen with ultrasonography, but small and more scattered deposits were better found on plain radiographs. Sonography proved to be reliable in the detection and localization of rotator cuff calcifications, but classification into a formative or resorptive phase could not be done. Because of this and the possibility of pathologic conditions of bone, plain radiographs should always be obtained prior to doing sonography.

Shoulder impingement syndrome: sonographic evaluation.

A method of shoulder sonography in which lateral and anterior elevation of the arm is used during scanning was demonstrated to be effective in cases of suspected impingement syndrome. The value of the method lies in its ability to demonstrate fluid collection in the subacromial-subdeltoid bursal system, with gradual distention of the bursa and lateral pooling of fluid to the subdeltoid portion while the arm is elevated. In 102 of 381 patients studied, surgical diagnosis was available for correlation. Among this group there were seven false-negative and three false-positive sonographic findings. A comparison of sonographic with surgical findings demonstrated a sensitivity of 81% and a specificity of 95% in stages I-III, and a sensitivity of 71% and a specificity of 96% in early stages I and II of the impingement syndrome. The results of dynamic shoulder sonographic examination with fluoroscopic radiography provide valuable information in patients with suspected early-stage impingement syndrome.