Assessment Of Rotator Cuff Tears Research Articles

Dynamic ultrasound assessment of rotator cuff tears: The finger compression technique

AbstractThe article aims to introduce the finger compression technique as a novel dynamic compression technique that can be easily incorporated into the routine sonographic examination to enhance its diagnostic performance in the investigation of rotator cuff tears. The application of the finger compression technique is demonstrated with illustrations, ultrasound images, and videos. The finger compression technique can be applied in challenging ultrasound shoulder scans. The technique enables visualisation of movement of hyperechoic debris or hypertrophic synovial tissue filling the defect of the rotator cuff tear during real‐time dynamic scanning. It also helps to milk bursal fluid into the tendon gap and across the torn tendon into the shoulder joint. The real‐time finger compression technique is a fast, easy and useful supplementary technique for confirming the diagnosis of rotator cuff tears in the presence of severe tendinopathy complicated by bursal thickening and may help to more accurately characterise rotator cuff tears when present.

Ultrasound Versus Magnetic Resonance Imaging as First-Line Imaging Strategies for Rotator Cuff Pathologies: A Comprehensive Analysis of Clinical Practices, Economic Efficiency, and Future Perspectives.

Rotator cuff injuries are a prevalent cause of atraumatic chronic shoulder pain, imposing a significant healthcare burden. This articlereviews the clinical presentation, diagnostic imaging modalities, practice variations, and economic efficiency considerations in the evaluation of rotator cuff pathologies. Ultrasound (US) and magnetic resonance imaging (MRI) are the primary imaging methods for diagnosing rotator cuff injuries. US provides real-time visualization but has limited tissue penetration, while MRI offers detailed anatomical information but is not a dynamic process. Studies show that MRI is superior to US with higher sensitivity and specificity. MRI is the gold standard, particularly for surgical planning, but US remains relevant when MRI is not feasible. Both require standardized protocols for evaluating tear dimensions and muscle atrophy. With the operator-dependent nature of US, MRI offers a more comprehensive assessment of rotator cuff tears and predictive insights for clinical outcomes. Practice variations exist in the management of rotator cuff pathologies, with some countries favoring US as the primary imaging modality and others relying more on MRI. These variations are influenced by factors like resource availability and healthcare system nuances. In Australia, current guidelines lean towardconservative management, potentially leading to delayed diagnoses and increased costs. The United States often favors MRI, while Canada advocates for US as the initial choice. Economic considerations play a significant role in selecting imaging modalities. While US is cost-effective, it may necessitate subsequent MRI examinations, contributing to inefficiencies in the diagnostic process. Studies suggest that a combined approach of US and MRI is less efficient and cost-effective than MRI alone. However, the use of both modalities rather than MRI aloneis common in clinical practice, adding to healthcare expenses. In conclusion, the choice of imaging modality for rotator cuff pathologies should consider factors such as diagnostic efficacy, cost-effectiveness, and resource availability. Radiologists play a pivotal role in guiding this selection and ensuring comprehensive evaluations. Future considerations should include the revision of management guidelines and the potential inclusion of shoulder pathologies in healthcare coverage to optimize patient care and healthcare expenditure.

Clinical Utility of DECT in Fat Fraction Assessment of Rotator Cuff Tears: A Comparative Analysis with MRI

Clinical Utility of DECT in Fat Fraction Assessment of Rotator Cuff Tears: A Comparative Analysis with MRI

Assessment of rotator cuff tears among bodybuilders in Lahore

Background: The current was performed on bodybuilders to see the shoulder rotator cuff injuries among them. A bodybuilder is a person who strengthens and enlarges the muscles of their body through strenuous exercise. The chances of injury in shoulder is much more than any other region of body because of excessive workout of upper body shoulder and chest than lower region. Objective: To determine the Assessment of rotator cuff tears among bodybuilders in Lahore. Methodology: It was the cross-sectional study. Data was collected by 161 bodybuilders on basis of inclusion and exclusion criteria. Convenient sampling technique was used in this study. Oxford shoulder score questionnaire along with manual physical testing for assessing the rotator cuff injury was used in this study. Data was analyzed by using SPSS. Results: In current study the mean age of respondents was 30.12 with SD 5.85. Minimum age was 20 and maximum age was 45 years.72.6% of the bodybuilders had right side dominant and 27.3 had left side dominant. 22.98% had 1-3 years of experience, 49.68 had 4-6 years of experience and 27.3 had 7-10 years of experience.31.67 had discomfort in their right shoulder and 58.3% had discomfort in left shoulder and 9.93 % had discomfort in both shoulders. 18.51% of the bodybuilders had positive lift of test for subscapularis injury, 40.71 positive drop arm test for supraspinatus and infraspinatus injury, 9.87% had positive horn blower test for teres minor and 30.86% of the bodybuilder had all the rotator cuff tests were negative its mean the other type of shoulder injury rather than rotator cuff. Conclusion: From current study, it was concluded that rotator cuff injury was the commonest injury among all the shoulder injuries. Among the rotator cuff the supraspinatus and infraspinatus was the commonest injured muscle. There should be proper trainer for muscle building so that injury can be prevented. As there was much high prevalence of rotator cuff injury was found in current study. Clinicians and strength and conditioning professionals should consider the biomechanical stresses and adaptations associated with weight training when prescribing upper extremity exercises. Keywords: Rotator cuff, Injury, Oxford shoulder score.

Reliability of Magnetic Resonance Imaging Criteria for the Preoperative Assessment of Rotator Cuff Tears: A Systematic Review

Background: Magnetic resonance (MR) imaging is the most common modality for assessment of the rotator cuff before and after surgery. Several classifications have been described aiming to define main tear characteristics. However, there is still confusion when it comes to the reliability of those classifications. Purpose: (1) To identify all MR classifications available in the literature for preoperative assessment of rotator cuff tears, (2) to summarize available data on the reliability of identified classifications, and (3) to assess the methodological quality of reliability studies. Study Design: Systematic review; Level of evidence, 4. Methods: This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All studies reporting MR assessment in patients with a superior or posterosuperior rotator cuff tear were included. After identification of the available MR criteria, reliability studies were analyzed. Descriptive statistics were used to summarize findings. Methodological quality was assessed using the Quality Appraisal of Reliability Studies checklist. Results: A total of 75 studies were included in this review. Eight categories of outcomes could be identified. Of the total, 62 studies reported interobserver reliability whereas 32 reported intraobserver reliability of some of the identified criteria. Each category reflected a variety of reliability, ranging from poor to excellent agreement. MR proved to be a reliable imaging modality to detect the structural integrity of the posterosuperior cuff, especially in cases of full-thickness tear; it was also reliable in terms of tear width and length and muscle atrophy based on a tangent sign or Thomazeau classification. All other classifications did not prove acceptable reliability. Methodological quality was high for 23 articles and moderate for 14. Conclusion: Preoperative MR is a reliable imaging modality to identify full-thickness tears, measure tear size and morphology, and identify muscle atrophy with tangent sign or Thomazeau classification. All other outcomes and classifications did not show acceptable reliability; therefore, caution is needed when using them for preoperative evaluation of a rotator cuff tear.

Correlation Between Clinical Diagnosis, MRI, and Arthroscopy in Diagnosing Shoulder Pathology.

IntroductionShoulder disorders are frequently encountered by clinicians and are a common cause of musculoskeletal pain in the general population. Clinical tests specific to each shoulder pathology, MRI, and arthroscopy are the most relied upon modalities of diagnosis used by many clinicians. The aim of this study was to correlate clinical tests and MRI with arthroscopy as the gold standard and whether a negative MRI with a positive clinical test could justify an arthroscopy.Materials and methodsA total of 120 consecutive patients who had a history of shoulder pain or instability were evaluated by clinical tests and MRI, and underwent arthroscopy. Based on the confirmatory findings of arthroscopy, they were classified as True Positive (TP), True Negative (TN), False Positive (FP) and False Negative (FN) for each modality i.e., clinical tests and MRI.ResultsClinical assessment of rotator cuff tears in comparison to arthroscopy yielded a sensitivity of 96.88%, specificity of 92.86% and diagnostic accuracy of 95%, whilst MRI had a sensitivity of 90.62%, specificity of 92.86% and diagnostic accuracy of 91.67%. In anterior labral lesions, clinical assessment had a sensitivity of 94.44%, specificity of 97.62 % and diagnostic accuracy of 96.67%, whilst MRI had a sensitivity of 83.33%, specificity of 92.86%, with diagnostic accuracy of 90%. Interestingly, in the clinical assessment of superior labral tear from anterior to posterior (SLAP) lesions, a sensitivity of 90%, specificity of 95%, and diagnostic accuracy of 93.33% were observed while MRI had a sensitivity of 60%, specificity of 92.50%, and diagnostic accuracy of 81.67%.ConclusionOn the basis of these results, clinical assessment appears to be an effective tool in diagnosing shoulder pathologies, whereas MRI, though reliable in the identification of rotator cuff tears and instability, does not identify patients with SLAP lesions effectively. This study reinforces the importance of a good clinical examination of the shoulder, especially in chronic pain and an uncertain MRI, therefore improving patient management.

Patient-Reported Outcomes Measurements Information System (PROMIS) upper extremity and pain interference do not significantly predict rotator cuff tear dimensions.

BackgroundProper diagnosis of rotator cuff tears is typically established with magnetic resonance imaging (MRI); however, studies show that MRI-derived measurements of tear severity may not align with patient-reported pain and shoulder function. The purpose of this study is to investigate the capacity for the Patient-reported Outcomes Measurements Information System (PROMIS) computer adaptive tests to predict rotator cuff tear severity by correlating preoperative tear morphology observed on MRI with PROMIS upper extremity (UE) and pain interference (PI) scores. This is the first study to investigate the relationship between tear characteristics and preoperative patient-reported symptoms using PROMIS. Considering the essential roles MRI and patient-reported outcomes play in the management of rotator cuff tears, the findings of this study have important implications for both treatment planning and outcome reporting.MethodsTwo PROMIS–computer adaptive test forms (PROMIS-UE and PROMIS-PI) were provided to all patients undergoing rotator cuff repair by one of three fellowship-trained surgeons at a single institution. Demographic information including age, sex, race, employment status, body mass index, smoking status, zip code, and preoperative PROMIS-UE and -PI scores was prospectively recorded. A retrospective chart review of small to large full- or partial-thickness rotator cuff tears between May 1, 2017 and February 27, 2019 was used to collect each patient’s MRI-derived tear dimensions and determine tendon involvement.ResultsOur cohort consisted of 180 patients (56.7% male, 43.3% female) with an average age of 58.9 years (standard deviation, 9.0). There was no significant difference in PROMIS-UE or -PI scores based on which rotator cuff tendons were involved in the tear (P > .05). Neither PROMIS-UE nor PROMIS-PI significantly correlated with tear length or retraction length of the supraspinatus tendon (P > .05). The sum of tear lengths in the anterior-posterior and medial-lateral directions was weakly correlated with PROMIS-UE (P = .042; r = -0.152, r2 = 0.031) and PROMIS-PI (P = .027; r = 0.165, r2 = 0.012).ConclusionRotator cuff tear severity does not significantly relate to preoperative PROMIS-UE and -PI scores. This finding underscores the importance of obtaining a balanced preoperative assessment of rotator cuff tears that acknowledges the inconsistent relationship between rotator cuff tear characteristics observed on MRI and patient-reported pain and physical function.

Assessment and treatment strategies for rotator cuff tears.

Tears of the rotator cuff are common and becoming an increasingly frequent problem. There is a vast amount of literature on the merits and limitations of the various methods of clinical and radiological assessment of rotator cuff tears. This is also the case with regard to treatment strategies. Certain popular beliefs and principles practiced widely and the basis upon which they are derived may be prone to inaccuracy. We provide an overview of the historical management of rotator cuff tears, as well as an explanation for how and why rotator cuff tears should be managed, and propose a structured methodology for their assessment and treatment.

Surgeon-Operated In-Office Ultrasonography for the Diagnosis of Rotator Cuff Tears: A Comparison with Magnetic Resonance Imaging

Objective: Few investigators have evaluated whether ultrasonography operated by a surgeon during a patient’s clinic visit is capable of obtaining a similar degree of accuracy as magnetic resonance imaging in regard to the diagnosis of rotator cuff tears and lesions of the biceps tendon. The purpose of this study was to clarify the accuracy of in-office ultrasonography for the diagnosis of rotator cuff tears in comparison to magnetic resonance imaging. Methods: One hundred and three patients (105 shoulders) with a clinical diagnosis of impingement and suspected rotator cuff tear, who subsequently underwent arthroscopic surgery were retrospectively enrolled in this study, including 7 males with 89 shoulders, and 33 females with 33 shoulders, and their mean age was 60.9 years (range, 30 to 83 years). The subjects were examined using ultrasonography and magnetic resonance imaging within three months pre-operatively per normal practice of the outpatient clinic. The two modalities were then compared to the reference standard, arthroscopic findings. Results: Intra-operatively, 79 full-thickness and 15 partial-thickness rotator cuff tears were found. The agreement between ultrasonography and magnetic resonance imaging for diagnosis of rotator cuff tears was statistically good; observed degree of agreement was 87% with Kappa coefficient of 0.73. Ultrasonography showed a sensitivity of 94% and a specificity of 100% for full-thickness tears, and a sensitivity of 80% and a specificity of 91% for partial-thickness tears. The agreement of the two modalities for diagnosis of lesions of the biceps tendon was also good; observed degree of agreement was 93% with Kappa coefficient of 0.76. In addition, ultrasonography showed comparable accuracy for classifying the size of rotator cuff tears to that of magnetic resonance imaging. Conclusion: Surgeon-operated in-office ultrasonography is an appropriate technique for the assessment of rotator cuff tears with a comparable sensitivity and specificity to that of magnetic resonance imaging.

Diagnostic accuracy of ultrasound for rotator cuff tears in adults: A systematic review and meta-analysis

To determine the diagnostic accuracy of ultrasound to detect partial and complete thickness rotator cuff tears based on all available clinical trials. An electronic search of databases registering published and unpublished literature was conducted. All diagnostic accuracy studies that directly compared the accuracy of ultrasound (the index test) to either arthroscopic or open surgical findings (the reference test) for rotator cuff tear were included. The methodological quality of each included study was assessed using the QUADAS form. When appropriate, pooled sensitivity and specificity analysis was conducted, with an assessment of the summary receiver operating characteristic (ROC) curve for each analysis. Sixty-two studies assessing 6007 patients and 6066 shoulders were included. Ultrasonography had good sensitivity and specificity for the assessment of partial thickness (sensitivity 0.84; specificity 0.89), and full-thickness rotator cuff tears (sensitivity 0.96; specificity 0.93). However, the literature poorly described population characteristics, assessor blinding, and was based on limited sample sizes. The literature assessing transducer frequency was particularly small in size. Ultrasonography is an appropriate radiological technique for the assessment of rotator cuff tears with an acceptable sensitivity and specificity. The diagnostic test accuracy of ultrasound is superior for the detection of full-thickness compared to partial-thickness cuff tears. Further study assessing the effect of transducer frequency is warranted.

Shoulder Ultrasound

Ultrasound is used increasingly in the investigation of the rotator cuff. It is as accurate as magnetic resonance imaging in the detection of rotator cuff tears and the assessment of tear size and can demonstrate atrophy and fatty infiltration in the rotator cuff muscles. This article reviews the anatomy and technique of shoulder ultrasound, the ultrasound findings in rotator cuff disease, the accuracy of ultrasound and magnetic resonance imaging in the assessment of rotator cuff tears and the role of interventional ultrasound of the shoulder.

Rotator cuff tears: should abduction and external rotation (ABER) positioning be performed before image acquisition? A CT arthrography study

To evaluate the impact of abduction and external rotation (ABER) positioning performed before image acquisition on the assessment of rotator cuff tears. Twenty-seven consecutive patients with clinically suspected rotator cuff tears underwent an initial CT arthrogram of the shoulder in neutral position, immediately followed by temporary ABER positioning, before a second CT acquisition in neutral position. Two observers blinded to potential pre-procedure ABER positioning independently analysed the randomly distributed images. Lesions were classified into partial-thickness (PT) and full-thickness (FT) tear subtypes. Lesion detection and measurements of pre- and post-ABER studies were compared. We found no influence of pre-test ABER positioning on FT detection or measurements. Every PT detected on pre-ABER study was also detected on post-ABER study (28/28 for reader 1, and 32/32 for reader 2). Seven and eight additional PT were found by readers 1 and 2, respectively, on post-ABER study. Lesion size increased after ABER in terms of area (P < 0.001 for both readers) and Ellman's grade (P = 0.02 and 0.002 for reader 1 and 2, respectively). ABER positioning before CT is associated with improved delineation of partial tears, a higher number of detected tears and modification of treatment planning.

Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography?

PurposeThe purpose of this study was to retrospectively evaluate sensitivity and specificity of a single magnetic resonance (MR) arthrography series in abduction external rotation (ABER) position compared with conventional MR arthrography for detection of supraspinatus tendon tears, with arthroscopy as gold standard, and to assess interobserver variability.Materials and methodsInstitutional review board approval was obtained; informed consent was waived. MR arthrograms of 250 patients (170 men and 80 women; mean age, 36 years) were retrospectively and independently evaluated by three observers. Oblique coronal T1-weighted fat-suppressed images, proton density, and T2-weighted images and axial T1-weighted images and oblique sagittal T1-weighted fat-suppressed images were analyzed to detect supraspinatus tendon tears. Separately, a single T1-weighted fat-suppressed oblique axial series in ABER position was evaluated. Both protocols were scored randomly without knowledge of patients' clinical history and arthroscopy results. Tears were subclassified, based on articular surface integrity and extension (Lee classification). Interobserver agreement was assessed by kappa statistics for all patients. Ninety-two of 250 patients underwent arthroscopy; sensitivity and specificity of ABER and conventional MR arthrography were calculated and compared using paired McNemar test.ResultsWeighted kappa values of ABER and conventional MR arthrography were 0.48–0.65 and 0.60–0.67, respectively. According to arthroscopy, 69 of 92 patients had an intact cuff, and 23 patients had a cuff tear (16 partial thickness and seven full thickness). There were no statistically significant differences between ABER and conventional MR arthrography regarding sensitivity (48–61% and 52–70%, respectively) and specificity (80–94% and 91–95%).ConclusionSensitivity and specificity of a single T1-weighted series in ABER position and conventional MR arthrography are comparable for assessment of rotator cuff tears.

Musculoskeletal ultrasonography: a pictorial review.

Curr Probl Diagn Radiol 2002;31:244-65.