Contribution of Imaging to the Diagnosis of Non-Traumatic Tendinopathies of the Thoracic Limb in a Resource-Constrained Country

Abstract

Introduction: Tendinopathy of the thoracic limb (TMT) is frequent, and is responsible for an important socio-professional handicap. Medical imaging, in particular, ultrasound has a major role in contributing to the diagnosis. As the use of ultrasound is recent in osteoarticular pathology, especially in Africa, we proposed to determine the contribution of imaging in the diagnosis of tendinopathy of the thoracic limbs in a country with limited resources. Patients and Method: A descriptive and analytical cross-sectional study of patients with tendinopathy of the thoracic limb who consulted the rheumatology department of the CNHU-HKM of Cotonou from August 6, 2019 to October 6, 2019. We evaluated the concordance of thoracic limb tendinopathy between imaging (radiography and ultrasound) and the clinic on the one hand and then between radiography and ultrasound on the other hand. The analysis of the collected data was carried out with the Epi-info software version 7.2.1.0. Then the concordance was evaluated by the kappa coefficient. Results: Fifty- two (52) patients with 104 joints were evaluated. The average age was 54.92 ± 3.40 years. Clinically, rotator cuff tendinopathy was the most frequent abarticular pathology (45.19%). The clinical-ultrasound agreement was strong (k = 0.7527) for the shoulders, very strong (k = 0.9360) for the elbows and moderate for the wrists (k = 0.6695). The clinical-radiographic agreement was weak (k = 0.2316) at the shoulder level and very weak (k = 0.2087) at the elbow level. The radio-ultrasound agreement was very low in the shoulders (k = 0.1522), elbows (k = 0.1859) and wrists (k = 0.0001). Conclusion: The contribution of imaging in the diagnosis of TMT remains certain even in a country with limited resources like ours. Ultrasound is a reliable examination for the diagnosis of non-traumatic tendinopathy of the thoracic limb with a good clinical-ultra- sound concordance and a weak radio-clinical and radio-ultrasound concordance.