Usefulness of ultrasound in diagnosing long head of the biceps tendon malposition in patients with rotator cuff tears.

PURPOSE: This study aimed to determine the role of preoperative shoulder ultrasonography (SUS) in detecting positional abnormalities of the long head of the biceps tendon (LHBT) and predicting subscapularis (SSC) tears in patients with rotator cuff injuries. METHODS: A total of 331 patients (365 shoulders) who had undergone arthroscopic shoulder surgery for the treatment of rotator cuff tears were included in the study. Their preoperative SUS and magnetic resonance imaging (MRI) findings were examined retrospectively to assess the presence of LHBT abnormalities at the bicipital groove. Using arthroscopic findings as the standard of reference, the sensitivity, specificity, and diagnostic accuracy of SUS and MRI were calculated for detection of LHBT malposition. Furthermore, the correlation between SSC rupture and preoperative LHBT condition was evaluated by MRI and SUS. RESULTS: LHBT malposition was preoperatively diagnosed with a sensitivity of 92%, specificity of 90%, and accuracy of 91% with SUS, and a sensitivity of 74%, specificity of 84%, and accuracy of 80% with MRI. Preoperative SUS was significantly superior to MRI in terms of sensitivity, specificity, and accuracy (p < 0.001 each). Further, the preoperative SUS LHBT findings could predict well the presence or absence of intraoperative SSC rupture (odds ratio: 1.73, p < 0.001). CONCLUSION: SUS is a useful diagnostic modality for preoperative detection of LHBT malposition and prediction of SSC tears in patients with rotator cuff tears.

Sonographic assessment of subacromial bursa distension during arm abduction: establishing a threshold value in the diagnosis of subacromial impingement syndrome.

PURPOSE: In this study, we aimed to establish a quantitative threshold value in the diagnosis of subacromial impingement syndrome by measuring the thickness of the subacromial bursa during abduction and adduction. MATERIALS AND METHODS: Forty-five patients with subacromial impingement syndrome and 54 healthy individuals underwent dynamic shoulder ultrasonography. The subacromial bursa, between the supraspinatus tendon margin and peribursal adipose tissue, was measured between the acromion and humeral head at its widest part. The subacromial impingement ratio was calculated by dividing the subacromial bursa thickness during abduction to the subacromial bursa thickness during adduction. Shapiro-Wilk test was used in the assessment of normal distribution of parameters. RESULTS: The mean subacromial bursa thickness in the abduction position was 1.8 ± 1.1 mm in the study group and 0.9 ± 0.3 mm in the control group. The mean subacromial bursa thickness in the adduction position was 0.9 ± 0.5 mm in the study group and 0.8 ± 0.3 mm in the control group. The subacromial impingement ratio showed a statistically significant difference between groups (p < 0.0001), and the ratio being 2.0 ± 0.5 in the study group and 1.2 ± 0.1 in the control group. For measurements performed in the abduction position, the best cut-off value was calculated as 1.3 mm, and sensitivity and specificity were 70.6 and 85.2%, respectively. The best cut-off value was 1.4 for the subacromial impingement ratio, and sensitivity and specificity were 88.2 and 96.3%, respectively. CONCLUSION: Subacromial impingement ratio is a very practical and reliable method in subacromial impingement syndrome diagnosis.

The shoulder in a production line: clinical and ultrasound study / O ombro em uma linha de produção: estudo clínico e ultrassonográfico

INTRODUÇÃO: A correlação entre dor no ombro, exame físico e ultrassonografias anormais é controversa no cenário ocupacional. OBJETIVO: Estabelecer a associação entre dor, exame físico e ultrassonografia em trabalhadores de uma indústria farmacêutica. PACIENTES E MÉTODOS: Cem trabalhadores foram convidados a participar do estudo e submetidos aos critérios de inclusão e exclusão; 93 foram incluídos neste estudo. Todos assinaram termo de consentimento e tiveram exame físico realizado por um dos autores. O exame ultrassonográfico foi realizado, no máximo, após um mês do exame físico por um operador experiente, que desconhecia o quadro clínico. RESULTADOS: houve correlação estatística entre dor e manobras clínicas, em 57 ombros, para o tendão supraespinhal (SE) (P = 0,000), e nenhuma correlação com as manobras para o tendão do bíceps (P > 0,05). Na comparação entre os achados clínicos e a ultrassonografia, as manobras de Neer, Hawkins e Jobe tiveram associação estatística (P < 0,05). A associação entre dor e ultrassonografia alterada foi estatisticamente significativa (16 dentre 57 ombros com dor, com P < 0,05), porém houve falsa-positividade significativa de achados ultrassonográficos em ombros assintomáticos (sete ombros). CONCLUSÃO: O diagnóstico preciso é um processo complexo que requer a associação de anamnese clínica e ocupacional, exame físico acurado e ultrassonografia realizada por um operador experiente.

INTRODUCTION: The correlation among shoulder pain, abnormal physical examination and ultrasonography is controversial in the occupational scenario. OBJECTIVE: Establish the association between pain, physical examination and ultrasounds in workers of a pharmaceutical industry. PATIENTS AND METHODS: One hundred workers were invited to take part in the study and submitted to the inclusion and exclusion criteria, and 93 were included. All enrolled patients gave written informed consent, and had a physical examination performed by one of the authors. Ultrasound examination was performed, at the latest one month of the physical examination, by an experienced operator who was blind to the clinical setting. RESULTS: There was statistical correlation between pain and clinical maneuvers in 57 shoulders for supraspinatus tendon (SE) (P = 0,000) and no correlation with biceps tendon maneuvers (P > 0,05). In the comparison between clinical findings and ultrasonography, the maneuvers of Neer, Hawkins and Jobe had statistical association (P < 0,05). The association between pain and altered ultrasonography was statistically significant (16 among 57 individuals with pain, with P < 0,05), but there was significant false-positive ultrasound findings in asymptomatic shoulders (7 individuals). CONCLUSION: The precise diagnosis is a complex process, which requires the association of clinical and occupational anamnesis, accurate physical examination and ultrasonography performed by an experienced operator.

The Usefulness and Indications of Arthrosonography to Differentiate Full-thickness Tears from Partial-thickness Tears of the Rotator Cuff

OBJECTIVE: To investigate the usefulness and indications of arthrosonography by testing if the new technique could provide additional information on the degrees of rotator cuff tears when compaired to the findings of conventional ultrasonographic examinations. METHOD: Thirty six patients, who were identified to have partial or full-thickness rotator cuff tears by conventional ultrasonography, were included. Intraarticular injection of 15 ml of fluid was performed via posterior approach under ultrasound-guidance, which was followed by arthrosonography. RESULTS: Among 26 patients with partial-thickness tear which was detected by the conventional ultrasonography, eight were identified to have full-thickness tears by the arthrosonography. Although the difference was not significant, the grade 3 partial-thickness tear in the conventional sonography had a higher rate of being identified as full- thickness tear in the arthrosonography than the grade 2 partial-thickness tears. The size of partial-thickness tear was increased after instillation of fluid in the arthrosonography. CONCLUSION: Arthrosonography would be useful in differentiating partial- and full-thickness tears. When a tear of the rotator cuff tendon, especially a grade 3 partial-thickness tear, is detected in the conventional sonographic examination, an obscured full-thickness tear should be suspected and subsequent arthrosonographic procedure could be administered to clarify the extent of the lesion. Moreover, arthrosonography might be helpful in detecting partial-thickness tears by making them appear larger after instillation of fluid.