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PubMed1997

[Ultrasound findings after shoulder dislocation].

AIM: Sonography of the shoulder is an effective method for detecting tears of the rotator cuff and bone lesions. The purpose of this study was to evaluate prospectively the sonographic findings after shoulder dislocation. METHODS: Sonography was performed on 208 patients with 210 shoulder dislocations, which were all verified by radiography. RESULTS: We diagnosed 62 rotator cuff lesions (29.5%), which were all in the group with traumatic shoulder dislocation. The incidence of tears in patients with first traumatic dislocation (n = 134) was 36.5%. 12 tears (21.8%) of the rotator cuff were noted in recurrent dislocations (n = 55). 23 fractures or bony avulsions of the greater tuberosity of the humerus (11%) and 168 Hill-Sachs lesions (80%) were seen. CONCLUSION: Sonographic examination of the shoulder revealed a significant amount of information that would remain undetected without the aid of expensive and/or invasive diagnostic tools.

Adolescent↗

PubMedDate not supplied

An operative technique for recurrent shoulder dislocations in older patients.

Recurrent anterior shoulder dislocation in the elderly is not as exceptional as it was once thought to be. That anterior shoulder dislocation in older patients is caused by a rotator cuff tear through the posterior mechanism is well accepted. However, in the subset of patients who have multiple recurrent or intractable dislocations develop, there may be combined pathologic conditions at work: large or massive rotator cuff tears together with anterior capsulolabral injuries such as a Bankart lesion or fracture of the glenoid rim. These patients have multiple recurrences because of disruption of both the anterior and the posterior stability mechanisms. We suggest a procedure that provides anterior stabilization with the capsular shift technique and that is supplemented by Bankart repair as necessary. The capsule transfer is performed superiorly and posteriorly to close the defect in the cuff. In this way a capsulodesis effect can be achieved that displaces the humeral head downward and produces active centering of the head in the course of abduction. Use of only the anterior capsule for the shift, and not the subscapularis tendon, does not compromise subscapularis function. Between 1990 and 1996, we used this technique to treat 16 patients older than 55 years of age with multiple recurrent anterior shoulder dislocation and massive rotator cuff tear. We report the results for the first 10 patients with a minimum follow-up of 2 years (range 2 to 7 years) and an average follow-up of 52 months. There were 7 excellent results, 2 good results, and 1 fair result according to the Rowe criteria. None of the patients had a recurrence of the dislocation. All the patients regained full or functional range of motion with stable shoulders, and most of them could perform activities of daily living without limitation. The average Constant score was 83%. This procedure appears to be successful in treating older patients with recurrent shoulder dislocation.

Aged↗

PubMed1996

[Indirect MR arthrography of the shoulder. An alternative to direct MR arthrography?].

INTRODUCTION: The purpose of this study was to evaluate the diagnostic power of indirect MR arthrography (I-MRA) particularly in rotator cuff tears. MATERIAL AND METHODS: Sonography, conventional MRI and I-MRA were compared with arthroscopy in 25 patients. Additionally literature about experience with the method in other shoulder disease was searched. RESULTS: Sensitivity and specificity in the detection of rotator cuff tears were 0.6 and 0.7 respectively using sonography, 0.66 and 1 with conventional MRI and 1 and 0.86 for I-MRA. I-MRA was especially useful in diagnosing partial tears. In other studies I-MRA showed good results in the evaluation of glenoid labral tears, with a sensitivity of 91% and a specificity of 92%. CONCLUSION: I-MRA can be successfully used to diagnose rotator cuff and labral tears.

Adult↗

PubMed1998

Ultrasound and operative evaluation of arthritic shoulder joints.

OBJECTIVE: To assess the diagnostic value of ultrasonography (US) in the evaluation of arthritic shoulder joints. METHODS: Twenty shoulders of 20 inpatients with arthritis were evaluated by US one day before the shoulder operation. Changes in the subacromial-subdeltoid bursa, biceps tendon and tendon sheath, rotatof cuff, and glenohumeral joint were recorded and compared with findings at operation. RESULTS: In the detection of effusion/hypertrophy in the subacromial-subdeltoid bursa, US had a sensitivity of 93% and a specificity of 83%. For a biceps tendon rupture US had a sensitivity of 70% and a specificity of 100%. US missed three intraarticular biceps tendon ruptures. For effusion/hypertrophy in the biceps tendon sheath US had a sensitivity of 100% and a specificity of 83%. For a rotator cuff tear US had a sensitivity of 83% and a specificity of 57%. US missed two small longitudinal rotator cuff tears. Three thin membranous, but intact, rotator cuff tendons were classified as full thickness tears by US. Synovial effusion/hypertrophy was detected by US and at operation in all of the 12 glenohumeral joints that were evaluable at surgery. CONCLUSION: US is a reliable method in experienced hands for the evaluation of inflammatory changes of an arthritic shoulder. In advanced stages of rheumatoid shoulder joints, however, US is not useful, because destructive bone changes and tendon ruptures change the normal anatomy and restrict shoulder motions, limiting the visibility of US.

Adult↗

PubMed1986

[Anatomical investigation of arterial distribution and clinical application of selective angiography of the shoulder joint].

The purpose of this paper is to apply selective angiography to the shoulder joint based on anatomical quantitative study. Prior to the selective angiography, I made the arterial casts of adult cadavers (30 joints) to investigate the vascular distribution of the rotator cuff, and the arterial specimen of fetus cadavers (60 joints) using a modification of Teichmann's technique with cold injection medium to observe the types of origin of the main arteries roentgenographically. Results of these anatomical studies showed the rotator cuff to have 4 main arteries, and each tendon of the rotator cuff to have 2 or more arteries from the scapular side and the humeral side, forming a vascular network on the tendon. The critical zone of the vascular network was in the subacromial part of the rotator cuff where the selective angiogram showed a variety of abnormal vasculature in clinical cases with lesions at the supraspinatus tendon.

Adult↗

PubMed1997

Biceps activity during shoulder motion: an electromyographic analysis.

Electromyographic responses in 44 shoulders from 30 subjects were examined. Fourteen shoulders from 13 patients had documented rotator cuff tears. The remaining volunteers had normal cuff integrity by history and examination. Electromyographic responses were recorded from the long head of the biceps, brachioradialis (elbow control), and from the supraspinatus (shoulder control). Elbow related biceps activity was minimized by using a brace locked in neutral forearm rotation and 100 degrees flexion. Analysis of normal and rotator cuff deficient data was performed in a masked fashion and electromyographic activity normalized as a percent of maximal muscle contraction during 10 shoulder motions based on the scapular plane. Normal shoulders in all ranges of active motion exhibited significant supraspinatus activity (20%-50% maximum muscle contraction). The response followed patterns expected for a shoulder stabilizer. In contrast, with every normal shoulder, biceps and brachioradialis activity remained insignificant (1.7%-3.6% maximum muscle contraction) and did not follow a patterned response. In patients with rotator cuff tears, biceps activity remained low (1.6%-4.4% maximum muscle contraction). As opposed to previous studies using electromyography about the shoulder, this trial examined shoulder specific biceps activity by relaxing the elbow. No significant biceps activity was observed in any shoulder, including patients with rotator cuff tears. Given these findings, any function of the long head of the biceps in shoulder motion does not involve active contractions.

Adult↗

PubMed1998

[Treatment strategy in first traumatic anterior dislocation of the shoulder. Plea for a multi-stage concept of preventive initial management].

The purpose of this paper is to outline the treatment protocol for the first time traumatic anterior shoulder dislocator, with options including conservative, arthroscopic and open surgical treatment. Regarding the subclassification of the first time traumatic anterior dislocater, it is imparitive to differentiate between the unidirectional dislocator with and without hyperlaxity. This subclassification takes into account the structural quality of the stabilizing ligamentous structures of the glenohumeral capsule. The patient with hyperelastic ligaments exhibit elastic deformation of the glenohumeral ligaments at the time of dislocation and thus, sustain less interstitial structural damage to the ligament. Therefore, these patients benefit from non-operative treatment. There are extrinsic and intrinsic factors which determine the outcome of the primary traumatic anterior shoulder dislocation. Extrinsic factors are those that are not related to changes in the shoulder morphology. The most important extrinsic factor is the age of the patient at the time of injury. The younger the patient at the time of injury the greater the risk of recurrence. As a rule, those patients 25 years of age or less, at the time of initial injury are less likely to spontaneously stabilize without surgical intervention, than they are to develop recurrence. Secondly, the type and level of sport participation is related to recurrence. Although the severity of the trauma can not be quantified, it certainly has an influence on recurrence. Immobilization remains controversial. A rehabilitation program is more likely to be successful in atraumatic instability. Patient compliance is important regardless of the type of treatment selected. Intrinsic factors include injury to the various anatomic structures about the shoulder, occurring at the time of primary anterior shoulder dislocation. A deep Hill Sachs lesion is more likely to result in recurrence secondary to both the impaction of the bone, as well as, the reduction of the area of articular surface. A displaced bony Bankart is a highly unstable situation secondary to the loss of the butress to retain the humeral head. In contrast to a Hill Sachs lesion or a bony Bankart, a concomittent fracture of the greater tuberosity is unlikely to result in recurrent dislocation. Isolated laberal detachment is not related to recurrence, but a complete disruption of the laberal ligament complex is highly correlated with recurrence. A rare subluxation erecta, as a special form of traumatic inferior instability, has a high recurrence rate. With increasing age there is a higher risk of concomittent rotator cuff tear. In most situations surgical repair of the rotator cuff tear results in resolution of the instability. The essential issue in determining the treatment protocol is to define concomittent hyperlaxity in the injured shoulder. Concomittent hyperlaxity precludes initial surgical treatment. The orthopedic surgeon treating the patient at the time of injury needs to design a concise treatment protocol for the patient based on the assessment of the extrinsic and intrinsic factors. An unreducable shoulder dislocation or associated vascular injury requires emergent intervention. Absolute indications for surgical treatment include: persistent dislocation, bony Bankart, a grossly displaced greater tuberosity fracture, and rupture of the subscapularis tendon. Surgical stabilization of primary anterior traumatic dislocation is indicated if the following strict criteria are met: adequate trauma, no self reduction, unidirectional instability without hyperlaxity, Hill Sachs lesion, age below 26 years, high level of sport activity and the special situation of luxatio erecta. Post primary stabilization is indicated for persistent subluxation, subjective instability or demonstrated pathologic instability tests. Rotator cuff tears due to traumatic dislocation in the elderly population require surgical repair.

Arthroscopy↗

PubMed2002

Sonography of the shoulder after arthrography (arthrosonography): preliminary results.

PURPOSE: The purpose of this study was to verify whether arthrosonography improves diagnostic accuracy in diseases of the shoulder and provides additional information for therapeutic planning, compared with conventional sonography. METHODS: We prospectively studied 113 consecutive patients with chronic shoulder pain. Sonography was performed before and after arthrography, with the radiologist blinded to the results of arthrography. When a rotator cuff tear was detected sonographically, its type, location, and size were recorded; we also evaluated any changes in the subacromial-subdeltoid bursa and any abnormalities in the biceps tendon sheath. The diagnostic accuracy of conventional sonography and arthrosonography was compared with that of arthrography for rotator cuff tear. Changes in the subacromial-subdeltoid bursa and biceps tendon sheath seen on conventional sonography were also compared with those seen on arthrosonography. RESULTS: The sensitivity and specificity of conventional sonography in the diagnosis of rotator cuff tear were 86% (25/29) and 95% (80/84), respectively; for arthrosonography, the values were 97% (28/29) and 95% (80/84), respectively. The differences in sensitivity and specificity for the 2 sonographic techniques were not statistically significant (p > 0.05). The accuracy in localizing the tear was also not significantly different between the 2 sonographic techniques. Synovial proliferation was more easily detected with arthrosonography than it was with conventional sonography in the subacromial-subdeltoid bursa (p < 0.01) and in the biceps tendon sheath (p < 0.0001). CONCLUSIONS: Our preliminary results suggest that although arthrosonography was not superior to conventional sonography in the diagnosis of rotator cuff tears, it may provide a better assessment of the size of tears and additional information about synovial proliferation in the subacromial-subdeltoid bursa and the biceps tendon sheath.

Female↗

PubMedDate not supplied

[Ultrasonography of the shoulder: the acromioclavicular joint].

In 95% of the patients complaining of shoulder pain, pain is consequent to mechanical impingement of the coraco-acromial arch on the rotator cuff. Acromioclavicular joint conditions play a major role (well over 50%) in initiating the process. This study was aimed at assessing the value of acromioclavicular investigations during shoulder US studies. September 1992 to September 1993, a hundred and seventy-four patients with shoulder pain underwent US exams of both shoulders and acromioclavicular joints. In 62% of patients rotator cuff tears (from less to more severe) were demonstrated, in 48% biceps tendon conditions (effusion, tendonitis, dislocation or tear) and in 31% aspecific degenerative changes of the rotator cuff. Three acromioclavicular joint cysts, a clavicular fracture and an acromioclavicular dislocation were also observed. The patients with US patterns of acromioclavicular conditions were 105 (60%); in 38% of cases, only capsular hypertrophy due to joint degeneration was observed. In 22% of cases the latter was associated with arthrosis-like changes of the articular rim. In 63% of cases rotator cuff tears were associated and in 37% of cases there were aspecific degenerative cuff changes. The authors believe that, especially in the latter cases, acromioclavicular joint US can be a useful approach to diagnosis and treatment.

Acromioclavicular Joint↗

PubMedDate not supplied

Kinetics of baseball pitching with implications about injury mechanisms.

Elbow and shoulder kinetics for 26 highly skilled, healthy adult pitchers were calculated using high-speed motion analysis. Two critical instants were 1) shortly before the arm reached maximum external rotation, when 67 N-m of shoulder internal rotation torque and 64 N-m of elbow varus torque were generated, and 2) shortly after ball release, when 1090 N of shoulder compressive force was produced. Inability to generate sufficient elbow varus torque may result in medial tension, lateral compression, or posteromedial impingement injury. At the glenohumeral joint, compressive force, joint laxity, and 380 N of anterior force during arm cocking can lead to anterior glenoid labral tear. Rapid internal rotation in combination with these forces can produce a grinding injury factor on the labrum. After ball release, 400 N of posterior force, 1090 N of compressive force, and 97 N-m of horizontal abduction torque are generated at the shoulder; contribution of rotator cuff muscles in generating these loads may result in cuff tensile failure. Horizontal adduction, internal rotation, and superior translation of the abducted humerus may cause subacromial impingement. Tension in the biceps tendon, due to muscle contraction for both elbow flexion torque and shoulder compressive force, may tear the anterosuperior labrum.

Acceleration↗

PubMed2005

Acupuncture for shoulder pain.

BACKGROUND: There are many commonly employed forms of treatment for shoulder disorders. This review of acupuncture is one in a series of reviews of varying interventions for shoulder disorders including adhesive capsulitis (frozen shoulder), rotator cuff disease and osteoarthritis. Acupuncture to treat musculoskeletal pain is being used increasingly to confer an analgesic effect and to date its use in shoulder disorder has not been evaluated in a systematic review. OBJECTIVES: To determine the efficacy and safety of acupuncture in the treatment of adults with shoulder pain. SEARCH STRATEGY: The Cochrane Controlled Trials Register, MEDLINE, EMBASE and CINAHL were searched from inception to December 2003, and reference lists from relevant trials were reviewed. SELECTION CRITERIA: Randomised and quasi-randomised trials, in all languages, of acupuncture compared to placebo or another intervention in adults with shoulder pain. Specific exclusions were duration of shoulder pain less than three weeks, rheumatoid arthritis, polymyalgia rheumatica, cervically referred pain and fracture. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted trial and outcome data. For continuous outcome measures where the standard deviations were not reported it was either calculated from the raw data or converted from the standard error of the mean. If neither of these was reported, authors were contacted. Where results were reported as median and range, the trial was not included in the meta-analysis, but presented in Additional Tables. Effect sizes were calculated and combined in a pooled analysis if the study end-points population and intervention were homogenous. Results are presented separately for rotator cuff disease, adhesive capsulitis, full thickness rotator cuff tear and mixed diagnoses, and, where possible, combined in meta-analysis to indicate effect of acupuncture across all shoulder disorders. MAIN RESULTS: Nine trials of varying methodological quality met the inclusion criteria. For all trials there was poor description of interventions. Varying placebos were used in the different trials. Two trials assessed short-term success (post intervention) of acupuncture for rotator cuff disease and could be combined in meta analysis. There was no significant difference in short-term improvement associated with acupuncture when compared to placebo, but due to small sample sizes this may be explained by Type II error. Acupuncture was of benefit over placebo in improving the Constant Murley Score (a measure of shoulder function) at four weeks (WMD 17.3 (7.79, 26.81)). However, by four months, the difference between the acupuncture and placebo groups, whilst still statistically significant, was no longer likely to be clinically significant (WMD 3.53 (0.74, 6.32)). The Constant Murley Score is graded out of 100, hence a change of 3.53 is unlikely to be of substantial benefit. The results of a small pilot study demonstrated some benefit of both traditional and ear acupuncture plus mobilization over mobilization alone. There was no difference in adverse events related to acupuncture when compared to placebo, however this was assessed by only one trial AUTHORS' CONCLUSIONS: Due to a small number of clinical and methodologically diverse trials, little can be concluded from this review. There is little evidence to support or refute the use of acupuncture for shoulder pain although there may be short-term benefit with respect to pain and function. There is a need for further well designed clinical trials.

Acupuncture Therapy↗

PubMedDate not supplied

An analysis of the diagnostic accuracy of the Hawkins and Neer subacromial impingement signs.

The purpose of this study was to assess the diagnostic accuracy of the Neer and Hawkins impingement signs for the diagnosis of subacromial bursitis or rotator cuff pathosis. Eighty-five consecutive patients undergoing shoulder arthroscopy by a single surgeon were documented prospectively for the positive and negative clinical and arthroscopic pathologic findings. The Neer sign was found to have a sensitivity of 75% for the appearance suggestive of subacromial bursitis; this compared with 92% for the Hawkins sign. For rotator cuff tearing, the sensitivity of the Neer sign was 85% and the sensitivity of the Hawkins sign was 88%. Specificity and positive predictive values for the two tests were low, being not much higher than pretest probability. The two tests had a high negative predictive value (96% for bursitis, 90% for rotator cuff tearing) when they were combined. The results are compared with those reported in the literature. We conclude that the Neer and Hawkins signs are sensitive for appearances suggestive of subacromial bursitis and rotator cuff partial or complete tearing with a high negative predictive value. However, they lack specificity in comparison with arthroscopic findings.

Adolescent↗

PubMed1995

[Spontaneous tendon ruptures. Etiology, pathogenesis and therapy].

Spontaneous tendon ruptures are ascribed to recurrent microtrauma resulting from continuous mechanical loading in a critical zone, to muscular imbalance combined with poor coordination as a result of inappropriate training, and also to deteriorating circulation with increasing age. Ruptures of the rotator cuff occur more frequently with increasing age, and the size of the rupture also correlates with age. The frequency of the complaint in men, the predominant involvement of the dominant shoulder, and also the above-average occurrence in occupations involving strenuous physical work indicate that degenerative change plays a role. In about 50% of patients presenting with a ruptured rotator cuff, the genesis is clearly traumatic. A trauma will almost always be the cause of an isolated rupture of the subscapularis tendon. The choice of reconstruction technique for a ruptured rotator cuff depends on the patient's age and level of activity in daily life. In the case of young patients, further surgical measures to repair the defect are indicated following failure of primary suture of the tendon, but in older patients subacromial debridement alone is considered the appropriate procedure. Rupture of the long head of the biceps tendon is usually a sequela of a rotator cuff rupture and the resulting loss of protective cover. Isolated ruptures of the long head of the biceps tendon are much rarer. They tend to occur in middle-aged patients and are usually the result of a relatively minor trauma. Ruptures of the distal biceps tendon are also relatively rare (3%) and are always of traumatic origin. There is no absolute indication for surgical intervention for a ruptured long head of the biceps tendon. Surgical repair is essential in the case of rupture of the distal biceps tendon. Transosseous reinsertion at the tuberosity of the radius is the recommended method of repair. Today's frequent cases of rupture of the Achilles tendon in the framework of sports activities are ascribed to inappropriate training procedures in combination with poor muscular coordination. An exogenous cause is the administration of local injections for pain relief in the form of a so-called tendon anesthetic. Today an increasingly important role is assigned to functional therapy with ultrasound support, although suturing the tendon is still the intervention of choice to meet the high functional demands imposed in the framework of top-level sports.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed2004

Shoulder stiffness: diagnosis.

BACKGROUND: Pain and stiffness of the shoulder is a common complaint, particularly in the 40-80 years age group. There are several causes of painful, stiff shoulders, but the most common cause in the fifth decade of life is idiopathic capsulitis ('frozen shoulder'). OBJECTIVE: This article summarises the functional anatomy of the shoulder joint, the pathology of the conditions that lead to shoulder stiffness, and methods to differentiate them. DISCUSSION: Clinical history and examination is effective in differentiating rotator cuff tears, impingement and frozen shoulder. Restriction of glenohumeral joint motion, particularly in external rotation, with no abnormality on X-ray is strongly suggestive of the diagnosis of frozen shoulder. Plain true anteroposterior X-rays are important to identify glenohumeral joint arthritis. Ultrasound is often helpful for confirming or denying rotator cuff tears when there is doubt on the clinical examination.

Humans↗

PubMed2004

[Impingement syndrome of the shoulder].

The impingement syndrome is a clinical entity characterized by shoulder pain due to primary or secondary mechanical irritation of the rotator cuff. The primary factors for the development of impingement are a curved or hook-shaped anterior acromion as well as subacromial osteophytes, which may lead to tearing of the supraspinatus tendon. Secondary impingement is mainly caused by calcific tendinopathy, glenohumeral instability, os acromiale and degenerative changes of the acromioclavicular joint. Conventional radiographs are initially obtained, mainly for evaluation of the bony structures of the shoulder. If available, sonography can be used for detection of lesions and tears of the rotator cuff. Finally, MR-imaging provides detailed information about the relationship of the acromion and the acromioclavicular joint to the rotator cuff itself. In many cases however, no morphologic cause for impingement syndrome can be found. While patients are initially treated conservatively, chronic disease usually requires surgical intervention.

Acromion↗

PubMedDate not supplied

Incomplete tears of the subscapularis tendon associated with tears of the supraspinatus tendon: cadaveric and clinical studies.

This study was undertaken to evaluate incomplete tears of the subscapularis tendon that occur in conjunction with small or medium-sized tears of the supraspinatus tendon. Fifty-two shoulders were examined in 26 embalmed cadavers. The average age at the time of death was 76.3 years. Rotator cuff tears were observed in 32 (61.5%) shoulders. Six (11.5%) shoulders had massive rotator cuff tears and were excluded from the study, leaving 46 shoulders for study. Twenty shoulders had a tear of the supraspinatus tendon, and 17 had a tear of the subscapularis tendon. All tears of the subscapularis tendon were articular-side incomplete tears. On histologic examination most pathologic changes of the subscapularis tendon were observed on the articular side of the upper portion. Lesions of the long head of the biceps brachii were identified in 14 (30.4%) shoulders. A statistically significant correlation was found between tears of the subscapularis tendon and the presence of lesions of the long head of the biceps brachii (P=.0014). In addition, the results of preoperative magnetic resonance imaging of 15 patients (average age, 62.9 years) with a surgically confirmed diagnosis of incomplete tears of the subscapularis tendon in conjunction with tears of the supraspinatus tendon were also evaluated. Incomplete tears of the subscapularis tendon could be identified on magnetic resonance imaging as an area of high signal intensity on axial T2-weighted images in all 15 shoulders studied.

Aged↗

PubMed2004

Detection of muscle atrophy on routine sonography of the shoulder.

OBJECTIVE: To describe the utility of sonography in visualizing muscle atrophy during routine sonographic examination of the shoulder for evaluation of the rotator cuff tendons. METHODS: A retrospective review of 199 shoulder sonographic examinations performed by 2 musculoskeletal radiologists trained in musculoskeletal sonography with knowledge of the typical sonographic findings of muscle atrophy was performed. Reports were reviewed for the presence of muscle atrophy. If atrophy was present, the reports from those examinations were rereviewed for concomitant rotator cuff abnormalities. RESULTS: Forty-five examinations (23%) showed atrophy in at least 1 muscle on the basis of the criteria of increased echogenicity and decreased bulk. There were a total of 81 individual muscles that showed atrophy, with the following distribution: 16% supraspinatus (n = 13), 31% infraspinatus (n = 25), 36% teres minor (n = 29), 2% subscapularis (n = 2), and 6% biceps brachii (n = 5). In 34 of the 45 examinations with muscle atrophy, there were 57 concomitant full-thickness tendon tears: 64% supraspinatus (n = 29), 38% infraspinatus (n = 17), 7% subscapularis (n = 3), 0% teres minor (n = 0), 16% long head of biceps (n = 7), and 2% deltoid (n = 1). CONCLUSIONS: Although primary sonographic evaluation of the painful shoulder concentrates on the tendons of the rotator cuff, we suggest that examination of the muscles should become a standard component of the comprehensive shoulder sonographic examination, particularly given the potential clinical implications of muscle atrophy on the outcome of rotator cuff surgery.

Adult↗

PubMed1994

[Differential diagnosis of pathological and pseudo-pathological shoulder. Clinico-ultrasonographic findings].

Clinical examination for rotator cuff tears is rarely conclusive and very difficult is the differential diagnosis with lesions of the axillary nerve. In a little hospital we chose to use first non invasive and cheaper tools for this diagnosis. 24 patients were first evaluated by a physiatric MD, and radiological and ultrasound studies were then performed. Ultrasonography (US) was done with a high frequency probe (7.5 MHz). More than 85% of our patients had, in this way a quick, cheap and non invasive diagnosis, and moreover a quick rehabilitation treatment. Only 3 patients were later studied invasively by arthrography or electromyography with needle, their treatment started later. In 3 patients US demonstrates a normal rotator cuff, and so a diagnosis of nervous lesion. Four patients had a complete large tear of the rotator cuff. In 14 patients US shows small or partial tear. Our non invasive diagnosis was quick, cheap and therapy started earlier with better final results.

Diagnosis, Differential↗