The role of ultrasound and magnetic resonance imaging in the evaluation of musculotendinous pathologies of the shoulder joint

Abstract

Aim: To evaluate and characterize the musculotendinous pathologies of shoulder joint using ultrasound (USG) and magnetic resonance imaging (MRI). Background and Objectives: The glenohumeral joint, being the most mobile and unstable of all the joints, is often prone to injuries. To compensate for its unstable bony anatomy, the shoulder is protected anteriorly, posteriorly, and superiorly by a capsule and tendons that form the rotator cuff. Sonography is often considered the first-line imaging modality in the assessment of cuff as well as in nonrotator cuff disorders. MRI is of value in cases of extensive abnormality that is often incompletely characterized by the initial sonographic examination, as in case of sonographically inaccessible areas. However, musculoskeletal imaging is truly a multimodality approach and in order to identify and characterize the lesion, a combination of modalities should be used. Materials and Methods: A prospective study was carried out on 75 patients in the Department of Radiodiagnosis, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune over a period of 2 years from July 2011 to September 2013. Patients from all age groups including both men and women with shoulder pain, suspected to be arising from the musculotendinous tissues of the shoulder joint, were taken up for study. Results: In our study, USG showed a sensitivity of 95.2%, specificity of 88.8%, and positive predictive value of 80% for demonstrating full-thickness tears. In case of partial-thickness tears, USG showed overall sensitivity of 94.7%, specificity of 85.7%, and positive predictive value of 90%. Overall accuracy of USG in detecting full-thickness as well as partial-thickness tears was 91%. Conclusion: In patients with shoulder complaints, USG is a reliable dynamic diagnostic tool. It reveals high diagnostic accuracy in detecting rotator cuff pathologies including cuff tears and tendinopathy. However, MRI has always been successful in overall assessment of joint structure. Its ability to evaluate labrum and various glenohumeral ligaments cannot be superseded by USG.