Ultrasound Features Associated With Shoulder Complaints: Calcifications Larger Than 6 mm in Young Patients and Positive Doppler Are Associated With Pain.

João Janeiro,Jorge Campos,João E Fonseca,Pedro Ninitas,Sofia C Barreira,Patrícia Martins

doi:10.3389/fmed.2021.715423

João Janeiro, Jorge Campos + Show 4 more

Open Access

https://doi.org/10.3389/fmed.2021.715423

Copy DOI

Abstract

Objectives: To identify ultrasound (US) features associated with the presence of shoulder complaints.Methods: This observational, case-control study, compared US findings between participants with and without shoulder complaints, matched for age, sex, and dominancy. Data was collected from February 2018 to June 2020. Two-tailed Fisher's and Mann-Whitney U-tests were used, with p-values < 0.05 considered significant.Results: A total of 202 participants were enrolled (median age 56 years, range 18–70, 155 women), comprising 140 cases and 62 controls. A calcification size ≥6 mm, when age < 56 (p = 0.02), and a distance to tendon insertion ≥6 mm, when age ≥56 (p = 0.009), were only found in symptomatic shoulders. Color Doppler in rotator cuff (RC) tendons predominated in the presence of symptoms (26/140 vs. 2/62, p = 0.003). An algorithm also combining the number of calcifications, tendon echotexture and insertional thickening, osseous irregularity, cuff tears, and subacromial effusion showed a 92% (57/62) specificity for shoulder pain on this study sample.Conclusion: Calcification diameter of 6 mm or more is associated with shoulder pain in patients younger than 56 years. A distance from calcification to tendon insertion of 6 mm or more is related to pain in older patients. Doppler signal also is associated with shoulder pain. An algorithm based on a set of specific ultrasonographic criteria have a strong association with the presence of symptoms.

Highlights

Shoulder is one of the most common anatomical sites for musculoskeletal pain, with a higher incidence in women and reaching an annual cumulative incidence of 2.4% among adults aged 45–64 years
Calcifications have long been associated with pain, and recognized to be present in asymptomatic shoulders [8]
US findings associated with shoulder pain have been described, substantial overlap exists between painful and asymptomatic shoulders

Summary

Introduction

Shoulder is one of the most common anatomical sites for musculoskeletal pain, with a higher incidence in women and reaching an annual cumulative incidence of 2.4% among adults aged 45–64 years. Calcifications have long been associated with pain, and recognized to be present in asymptomatic shoulders [8]. The size of calcification is relevant and shoulders with radiological detected calcific deposits of >1.5 cm in length have the highest chance of being symptomatic [9, 10]. Ultrasound (US) is considered to be reliable in the detection and localization of RC calcifications [12] and US assessment of patients with known calcifications found larger calcified plaques in symptomatic than in asymptomatic shoulders [13]. The evaluation of a general population based cohort (women with and without calcified deposits) could not confirm the relationship between pain and calcification size and found calcifications larger than 1 cm to be unusual [14]. Thickening, echotexture changes and tears in RC tendons, subacromial bursal widening, and signs of subacromial impingement and acromioclavicular osteoarthritis have been described in painful and in asymptomatic shoulders [15, 16]

Objectives

Methods

Results

Discussion

Conclusion