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
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]
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