Diagnostic value of angled oblique sagittal images of the supraspinatus tendon for the detection of rotator cuff tears on MR imaging.

PURPOSE: The goal of this study was to evaluate the added value of sagittal T2-weighted magnetic resonance imaging (MRI) of the supraspinatus tendon by comparison with a standard MRI protocol for the evaluation of the rotator cuff. MATERIALS AND METHODS: This retrospective single center study included 100 patients referred for MRI for suspected rotator cuff injuries. Two observers compared sagittal T2-weighted fat-suppressed orthogonal images of the distal portion of the supraspinatus muscle ("cuff" protocol) to those acquired according to the standard MRI protocol, which focuses on the glenoid. The two observers evaluated the appearance of each rotator cuff tendon and indicated whether the "cuff protocol" facilitated interpretation. RESULTS: The sensitivity and specificity for the detection of lesions ranged from 79 to 97% and 80 to 99% respectively. The interobserver variability coefficient was good for the supraspinatus (k=0.744). The new sequence helped localize and characterize rotator cuff injuries in 24-40% of the cases for the supraspinatus, in particular for partial tears and tendinopathies. CONCLUSION: The results of the specific MRI "cuff" protocol focusing on the supraspinatus are good, and helps facilitate interpretation of MRIs of the rotator cuff by non-specialist radiologists, in particular of the supraspinatus muscle.

Do subacromial ultrasonography findings predict efficacy of intra-bursal injection? Prospective study in 39 patients.

BACKGROUND: Ultrasonography has become an investigation of choice in the management of shoulder pain. The objective of this study was to determine whether the efficacy of subacromial-subdeltoid bursa injection correlated with the ultrasound findings. MATERIAL AND METHODS: We prospectively recruited patients who were seen between November 2012 and November 2013 for subacromial pain and whose rotator cuff was either intact or showed a full-thickness tear less than 1cm in length. A standardised physical examination of the shoulder was followed immediately by static and dynamic ultrasonography, intra-bursal injection of lidocaine, and a repetition of the same physical examination. Recorded ultrasonography features were the appearance of the bursa, shape of the coraco-acromial ligament, and bursal deformation induced by passage under the coraco-acromial ligament during dynamic imaging. A response to the injection was defined as greater than 75% improvements in at least three of the physical examination parameters. RESULTS: We included 39 patients with a mean age of 56.7 years. Ultrasonography showed abnormalities of the bursa in 30 patients, including 1 with an intra-bursal effusion, 10 with thickening, and 19 with both. Deformation of the bursa under the coraco-acromial ligament was noted in 26 patients. The proportions of patients with bursal effusion and with bursal thickening were similar in the 20 responders and 19 non-responders. Neither were any significant differences found for coraco-acromial ligament shape or bursal deformation under the ligament. CONCLUSIONS: No correlation was found between ultrasonography findings and the efficacy of a local anaesthetic injection into the subacromial bursa. These findings suggest that ultrasound abnormalities may constitute mere physiological changes, in keeping with earlier studies in asymptomatic individuals. Thus, subacromial impingement may be currently overdiagnosed.

Contribution of static and dynamic ultrasound in cubital tunnel syndrome.

INTRODUCTION: Electroneuromyography (ENMG) is the gold standard examination in cubital tunnel syndrome (CuTS), but sheds no light on etiology. High-resolution ultrasound (HRU) analyzes the anatomic abnormalities and physical properties of the ulnar nerve (UN) and enables dynamic study. The present non-randomized prospective study compared HRU with clinical, ENMG and intraoperative findings. MATERIAL AND METHODS: Sixty patients were included. The McGowan clinical classification as modified by Goldberg was employed, and ENMG lesions were ranked for severity. HRU screened for morphologic abnormalities of the ulnar nerve and cubital tunnel, measuring UN cross-sectional area (UNCSA) and flattening index (FI) in the cubital tunnel, in extension and flexion. UN stability was assessed. RESULTS: Ultrasound found 2 stenoses, 29 pseudoneuromas 25 dedifferentiations. There were 16 morphologic abnormalities. Mean cubital tunnel UNCSA (in cm(2)) and FI were respectively 0.112 and 1.549 in extension and 0.117 and 1.827 in flexion. Nineteen cases of UN instability were found on HRU, versus 17 intraoperatively. Only 8 patients showed no abnormality on HRU. Pseudoneuroma or dedifferentiation on HRU correlated with clinical stage (P=0.2579 and 0.2615, respectively). Dedifferentiation was associated with severe abnormality on ENMG (P<0.5). Thirty-two stenoses, 18 pseudoneuromas and 10 epitrochlearis anconeus muscles were found intraoperatively, matching HRU abnormalities. DISCUSSION: The present findings were comparable to those of the literature. Cubital tunnel UNCSA was elevated in case of CuTS, with cut-off at 0.112 cm(2). FI was elevated in flexion (P=0.0063). The rate of UN instability was 32%, compared to 21-60% in the literature. HRU findings matched the clinical and ENMG classifications. HRU proved to be an effective diagnostic tool for CuTS and its etiologies. LEVEL OF EVIDENCE: IV.