Subacromial-subdeltoid Bursitis Research Articles

Exploring shoulder joint pain: a comparative analysis of dynamic ultrasonography and magnetic resonance imaging

BACKGROUND: To evaluate shoulder joint pain, the study concentrated on evaluating the diagnostic accuracy of ultrasonography and magnetic resonance imaging. AIM: By comparing the results from both modalities within the same patient group, the study aimed to identify potential challenges in image interpretation, underscoring the limitations of ultrasonography and magnetic resonance imaging. MATERIALS AND METHODS: Patients with shoulder joint pain were included through purposive sampling. These patients underwent ultrasonography and magnetic resonance imaging, and the results were correlated. Various shoulder pathologies, including tendon tears, bursitis, degenerative changes, calcifications, and impingement, were analyzed. RESULTS: The study comprised 35 patients who underwent ultrasonography and magnetic resonance imaging detecting pathologies such as subscapularis and supraspinatus tendon injuries, partial and full-thickness tears, peribicipital tendon fluid, subcoracoid and subacromial-subdeltoid bursitis, acromioclavicular joint degeneration, tendon calcification, and impingement. Comparative analysis showed varying sensitivities, specificities, positive predictive values, negative predictive values, and accuracy for different pathologies. CONCLUSION: Compared with ultrasonography, magnetic resonance imaging demonstrated greater sensitivity and specificity in identifying conditions causing shoulder pain. Ultrasonography’s affordability, real-time capabilities, and ability to compare results with the unaffected side make it a useful first diagnostic step for shoulder pain. Ultrasonography, although a quick and cost-effective initial diagnostic tool, has limitations, including operator dependence and lower sensitivity in certain conditions. In contrast, magnetic resonance imaging is employed as a confirming measure or in instances where diagnosis is challenging. The study emphasized the complementary roles of ultrasonography and magnetic resonance imaging in the diagnosis of shoulder joint pain, with magnetic resonance imaging as the more accurate and complete imaging modality.

Ultrasound Findings in Adult Patients with Chronic Shoulder Pain Having No History of Trauma

OBJECTIVE: To evaluate the frequency of non-traumatic chronic shoulder pain sonographically in the local population. METHODOLOGY: This cross-sectional study was conducted at the Department of Radiology, Combined Military Hospital Malir, from March to October 2020. A history of shoulder pain of more than one month duration was included. Patients with a History of shoulder dislocation, neurological, renal, hepatic and cardiac diseases were excluded. The sample size was 196. A non-probability consecutive sampling technique was employed. SPSS version 23 was used for statistical analysis. RESULTS: 196 patients (69.9% males and 30.1% females) with non-traumatic shoulder pain (56.4 % right side and 43.4% left) were scanned. The mean age was 42.80±11.20 years. Out of 196, 118(60.2%) were having complaints in dominant limbs (right 51.0% and left 9.2%); 78(39.8%) were having pain in non-dominant limbs (right 6.6% and left 33.2%). Significant findings were supraspinatus partial tear (46.9%), sub-acromial sub-deltoid bursitis(8.2%), and biceps tenosynovitis(6.1%), adhesive capsulitis, a complete tear of supraspinatus tendon, impingement syndrome, joint effusion, subscapularis tendon tear and tenosynovitis. 44(22.4%) patients had two pathologies, and 31 (15.8%) patients had three pathologies, respectively. Significant co-existent findings were biceps tenosynovitis (13.8%), Impingement syndrome (9.2%), bursitis (8.2%) and joint effusion (7.1%). Age and number of pathological were moderately positively correlated, r (194) = 0.46, p < 0.01 and keeping CI = 95%. CONCLUSION: Partial tears of the supraspinatus tendon were the most common pathology in non-traumatic shoulder myalgia, diagnosed on ultrasound, followed by sub-acromial sub-deltoid bursitis and biceps tenosynovitis, having moderate linear relation with age. KEYWORDS: Shoulder pain, Impingement syndrome, Rotator Cuff Tears, Tenosynovitis, Ultrasound Shoulder

Pattern of Radiographic and Sonographic Findings of Adult Patients Presented with Shoulder Pain at Tikur Anbessa Hospital, Addis Ababa, Ethiopia.

Shoulder pain is one of the most common presentations in the orthopedic clinic. Multiple factors have been found to cause shoulder pain. Radiographs and ultrasound are widely available, relatively cheap modalities in assessing shoulder pain. The aim of this study is to assess the radiographic and sonographic imaging patterns of shoulder pain. A descriptive prospective cross-sectional hospital-based study was conducted at the Department of Radiology of Tikur Anbessa Specialized Hospital among patients with shoulder pain that came for imaging from August 2021-January 2022. Of the 73 patients with shoulder pain included in the study, 67% were females while 33% males. The mean age was 51.7 years. Radiographs found pathology in 53% of the cases. Acromioclavicular joint osteoarthritis, greater tuberosity degenerative changes, rotator cuff calcification were common radiographic findings. Ultrasound detected pathologies in 87% of the cases. The common pathologies were rotator cuff pathologies, biceps tendon pathologies, acromioclavicular joint degeneration, greater tuberosity degenerative changes, subacromial subdeltoid bursitis, and adhesive capsulitis. There was a significant association between greater tuberocity degenerative changes and supraspinatous pathologies with age, greater tuberocity degenerative changes with supraspinatous pathologies, acromiohumeral distance of <7mm with supraspinatous pathology. Radiographs and ultrasound are valuable imaging modalities for shoulder pain. Low acromiohumeral interval, greater tuberosity degenerative changes, and acromioclavicular joint osteoarthritis are associated with rotator cuff tears. Rotator cuff pathologies are the most common pathologies observed in ultrasound. We recommend ultrasound to be second step after radiograph due to its low cost and wide availability.

SIRVA: Shoulder injury related to vaccine administration.

Shoulder injury related to vaccine administration (SIRVA) is a prolonged episode of shoulder dysfunction that commences within 24 to 48 hours of a vaccination. Symptoms include a combination of shoulder pain, stiffness, and weakness. There has been a recent rapid increase in reported cases of SIRVA within the literature, particularly in adults, and is likely related to the mass vaccination programmes associated with COVID-19 and influenza. The pathophysiology is not certain, but placement of the vaccination in the subdeltoid bursa or other pericapsular tissue has been suggested to result in an inflammatory capsular process. It has been hypothesized that this is associated with a vaccine injection site that is "too high" and predisposes to the development of SIRVA. Nerve conduction studies are routinely normal, but further imaging can reveal deep-deltoid collections, rotator cuff tendinopathy and tears, or subacromial subdeltoid bursitis. However, all of these are common findings within a general asymptomatic population. Medicolegal claims in the UK, based on an incorrect injection site, are unlikely to meet the legal threshold to determine liability.

Rice Grain Bursitis: Rare Manifestation of TB in Wrist Joint

This case report highlights about rice grain bursitis- rare manfiestation of TB in wrist joint. Subacromial-subdeltoid bursitis of a shoulder with rice bodies is relatively uncommon. The understanding of the pathogenesis of rice body formation is yet approximate only but some clinical conditions like rheumatoid arthritis, tuberculous arthritis, seronegative inflammatory arthritis, juvenile rheumatoid arthritis and osteoarthritis are related to it. A 30yr Male patient presented with complaints of pain and swelling in the wrist joint , which was insidious in onset. It was associated with evening rise in temperature. Frequenetly erosion of the underlying bone, secondary osteomyelitis and median nerve encasement are present.

Comparative evaluation of ultrasonography with magnetic resonance imaging in the diagnosis of shoulder ailments

Background: Shoulder pain encompasses a diverse array of pathologies and can affect as many as one quarter of the population depending on age and risk factors. It may be caused by problems with the neck, glenohumeral joint, acromioclavicular joint, rotator cuff, or other soft tissues around the shoulder. Aims and Objectives: The main aim of the study is to compare the diagnostic accuracy of ultrasound (US) shoulder and magnetic resonance imaging (MRI) of the shoulder in the diagnosis of shoulder ailments. Materials and Methods: This is a comparative study done in Department of Radiology, Aarupadai Veedu Medical College and Hospital, Pondicherry. In total, 54 patients were included for ultrasonography (USG) and MRI examination of shoulder ailments. The statistical analysis was done using Statistical Package for the Social Sciences Version 21.0 statistical analysis software. Results: Subacromial-Subdeltoid Bursitis is the most common finding. US detects partial-thickness tears with a sensitivity of 63.3% and a specificity of 70.8% and full-thickness tears with a sensitivity of 80.0% and a specificity of 91.8%. Trauma was the etiology in only a few patients. MRI is more sensitive than USG in identifying labral and capsular pathologies. MRI is the most sensitive and specific modality for the establishment of shoulder pain. MRI is useful in cases in which the diagnosis is uncertain on USG. Conclusion: MRI is recommended as a secondary method since it provides more information about the extent of tendons and has a lower artifact risk.

Partial infraspinatus tear with bursitis following an mRNA vaccination: a case report.

A 52-year-old Thai female without preexisting shoulder pathology and symptom had developed left shoulder pain for 3 days. Two weeks prior to shoulder pain, she received an mRNA COVID-19 vaccination. She positioned her arm in combined internal rotation with 60° of arm abduction. Her symptoms were pain in all directions of shoulder motion and tenderness at the bicipital groove and over the deltoid area. The testing of the rotator cuff power of the infraspinatus tendon showed pain. An MRI showed infraspinatus tendinosis with a low-grade (almost 50%) bursal-surface tear at the footprint of the superior fiber with associated overlying subacromial-subdeltoid bursitis. She was treated with both intraarticular and subacromial corticosteroid injections (triamcinolone acetate (40mg/ml) 1ml+1% lidocaine with adrenaline 9ml). She did not respond to oral naproxen but responded well to intraarticular and subacromial corticosteroid injections. The best way to deal with SIRVA is to prevent this condition by using the correct injection technique. First, the injection site should be two or three fingerbreadths below the mid-acromion process. Second, the needle's direction should be perpendicular to the skin. Third, using the correct needle penetration depth.

Shoulder injury related to vaccine administration following SARS-CoV-2 inoculation: Case series and review of literature

IntroductionShoulder Injuries Related to Vaccine Administration (SIRVA), describes those cases of shoulder severe post-inoculation complications, including pain and prolonged disability. Most of the reported cases have been secondary to influenza vaccination. This study retrospectively describes a series of 18 patients following SARS-CoV-2 inoculation and compares the findings with those previously reported for other vaccines. Materials and methodsInclusion criteria was onset of symptoms within 48 h after injection, symptoms duration of at least seven days, and restricted range of motion in absence of symptoms prior to vaccination. Average age was 59.4 years old (38–76), and 72.2% were women. ResultsIn many cases (58%) the initial diagnosis was not clear, which lead to incorrect treatment. The most common pathological finding was subacromial-subdeltoid bursitis (66.6%). All patients who received depot corticosteroids followed by a gentle rehabilitation program showed strong clinical improvement but did not completely resolve the symptoms at 7.2 months average final follow-up. Surgical intervention was necessary in one of the patients due to the persistence of symptoms despite conservative treatment. ConclusionsShoulder injury related to vaccine administration is rare, but when present, its torpid evolution makes it difficult to treat. We have found in our case series a similar pattern to that already described for other vaccines. A high index of suspicion helps to pick up the condition promptly and early treatment can bring satisfactory outcome.

Magnetic resonance imaging findings in patients with polymyalgia rheumatica.

To describe the prevalence of magnetic resonance imaging (MRI) findings in patients with the clinical diagnosis of polymyalgia rheumatica (PMR). Sixteen consecutive patients with untreated PMR, meeting the American College of Rheumatology criteria, underwent MRI examinations of the shoulder(s), hip(s), or both, depending on clinical complaints. Six patients also underwent MRI of the spine. We evaluated 24 shoulders, among which we identified subacromial-subdeltoid bursitis in 21 (87.5%), glenohumeral joint effusion in 17 (70.8%), and fluid distention of the long head of the biceps tendon sheath in 15 (62.5%). Peritendinitis and capsular edema were observed in 21 (87.5%) and 17 (70.8%) shoulders, respectively. We also evaluated 17 hips, identifying hip joint effusion in 12 (70.6%), trochanteric bursitis in 11 (64.7%), peritendinitis in 17 (100%), and capsular edema in 14 (82.4%). All six of the patients who underwent MRI of the spine were found to have interspinous bursitis. Subacromial-subdeltoid bursitis, glenohumeral joint effusion, and hip joint effusion are common findings in patients with PMR. In addition, such patients appear to be highly susceptible to peritendinitis and capsular edema. There is a need for case-control studies to validate our data and to determine the real impact that these findings have on the diagnosis of PMR by MRI.

Ultrasound-guided Treatments for the Painful Shoulder.

Shoulder pain is an extremely common condition. The painful shoulder may be the result of a wide spectrum of underlying pathological conditions, including calcific tendinopathy of the rotator cuff, subacromial-subdeltoid bursitis, acromioclavicular or glenohumeral arthritis, tenosynovitis of the long biceps tendon, rotator cuff lesions, and many other less common conditions. Ultrasound imaging is an effective tool for the diagnosis and also for the image guidance of treatment of the majority of these conditions. Several ultrasound-guided procedures are effective for pain relief, such as percutaneous irrigation, intra-bursal or intra-articular drugs injection, fluid aspiration, neural block. This review article aims to summarize and discuss the most common treatment possibilities with ultrasound guidance for the painful shoulder.

Shoulder Injury Related to Vaccine Administration and a Growing Challenge: A Focused Review.

Shoulder injury related to vaccine administration (SIRVA), an entity that causes acute shoulder pain and may limit range of motion (ROM) after vaccination, is a condition where a small but significant percentage of patients are experiencing in light of the current push for mass immunizations against SARS-CoV-2 worldwide. A search of literature related to SIRVA was performed across multiple electronic databases. Women, patients reporting vaccine injection location to be too high, and patients without prior history of shoulder pain were the most common historical factors in those experiencing SIRVA. Tenderness to palpation and limited shoulder ROM were the most associated physical examination findings. When using magnetic resonance imaging, tendinopathy, subacromial-subdeltoid bursitis, and rotator cuff tears (partial or complete) were the most common findings. Radiographic imaging rarely aided the diagnosis. SIRVA is an entity that health care providers should be aware of to improve the care of patients that may experience these symptoms after vaccine administration.

Neuromuscular Ultrasound P-NU001. Ultrasound assessment for shoulder pain: Evaluation of etiology in urban area of Jakarta

Introduction . Shoulder pain is the third most common cause of musculoskeletal problems with chronicity and high recurrence rate. Due to its superficial location, Ultrasound imaging (US) can be used to assess associated pathological conditions. We try to identify the frequency of US-diagnosed shoulder disorders in our clinical practice. Methods . We reviewed and analysed 49 shoulder ultrasound reports of patients with shoulder pain (sub-acute and chronic) from our neurology department in MRCCC Siloam Hospitals Jakarta. All of the patients were referred to radiology department after initial assessment from neurologist. Patients were assessed for their biceps tendon, subscapularis tendon, supraspinatus tendon, infraspinatus and teres minor tendon and also evaluated for acromioclavicular joint and posterior structures such as posterior glenohumeral joint recess. Results . The most frequently diagnosed pathology was calcified (chronic) tendinopathy (30.6%), followed by non-calcified tendinopathy (22.4%), subacromial-subdeltoid bursitis (22.4%), acromioclavicular (AC) joint stenosis (14.3%), and miscellaneous disorders such as lipoma and fibroma (4.1%). There were 3 cases (6.2%) where no specific disorder was found. In the tendinopathy group (calcified and non-calcified), long biceps tendon was the most frequently affected tendon (46.4%), followed by supraspinatus tendon (39.3%) and subscapularis tendon (14.3%). Conclusion . Among patients presenting with shoulder pain, tendinopathy is the most common disorder found using ultrasound assessment of shoulder, followed by bursitis, and acromioclavicular joint stenosis.

Role of Magnetic Resonance Imaging and Ultrasonography in Evaluation of Chronic Non osseous Shoulder Pain.

Background: Chronic shoulder pain is a common clinical presentation. It is of osseous or non-osseous origin. In non-osseous shoulder pain, proper diagnosis is critical. Magnetic resonance imaging [MRI] is the standard diagnostic modality. However, it is expensive and not available in many medical centers. Thus, the availability of cheap alternative is crucial. Aim of the work: The current research aimed to assess the diagnostic performance of ultrasonography versus conventional MRI in different causes of chronic non-osseous shoulder pain. Patients and Methods: Fourty patients with chronic shoulder pain due to different causes were participated in the current work. They were selected from Al-Azhar University Hospital [Damietta]. All were assessed on clinical basis [history, physical examination and laboratory investigations]. Then, all were submitted to radiological investigations [Plain X-ray, shoulder ultrasound, and Magnetic resonance imaging]. The diagnostic value of ultrasound was estimated versus that of magnetic resonance imaging. Results: by ultrasound, tendinosis was reported in 55.0%, partial thickness tear in 27.5%, articular surface in 20.0%, full thickness tear in 12.5%, bursal surface [7.5%], neoplastic [2.5%] and infraspinatus tendon full thickness tear [2.5%]. Ultrasound able to diagnose supraspinatus tendinopathy [91.7%], full thickness complete tear [83.3%], supraspinatus impingement [85.3%], subacromial subdeltoid bursitis [92.0%] and long head biceps tenosynovitis [84.2%]. Otherwise, ultrasound specificity is over its sensitivity power for partial thinness tear on articular [80.0%] or bursal surfaces [85.3%], full thickness complete tear [94.1%], shoulder joint effusion [92.3%], LHB tenosynovitis [85.7%] and labral tears [100.0%]. Conclusion: Shoulder ultrasound could be considered as a reasonable alternative to magnetic resonance imaging in the diagnosis of different causes of chronic shoulder pain. However, its value widely different from condition to another. Thus, it could be used as a rapid screening tool, and the use of MRI could be ascribed for specific conditions [cases with lower ultrasound sensitivity].

Comparison of Shoulder Ultrasonographic Assessments between Polymyalgia Rheumatica and Frozen Shoulder in Patients with Bilateral Shoulder Pain: A Comparative Retrospective Study.

This study aimed to assess and compare the ultrasonographic (US) pathologic findings in patients with polymyalgia rheumatica (PMR) and bilateral frozen shoulder (FS). We included 19 patients with clinically diagnosed PMR and 19 patients with stage II bilateral FS. The US evaluation included the assessment of subacromial-subdeltoid (SASD) bursitis, long head of biceps (LHB) tenosynovitis, and posterior and inferior glenohumeral (GH) synovitis. Unilateral SASD bursitis was noted significantly more frequently in PMR patients than in bilateral FS patients (p = 0.001). There were no significant differences in the incidence of unilateral LHB tenosynovitis and posterior GH synovitis between PMR and bilateral FS patients (p = 0.108 and p = 0.304, respectively). Unilateral inferior GH synovitis was more common among bilateral FS patients than among PMR patients (p < 0.001). Bilateral SASD bursitis and LHB tenosynovitis were noted significantly more frequently in PMR patients than in bilateral FS patients (p < 0.001 and 0.049, respectively). Significant differences were not observed in the incidence of bilateral posterior GH synovitis between PMR and bilateral FS patients (p = 0.426). Bilateral inferior GH synovitis was more common among bilateral FS patients than among PMR patients (p = 0.044). The US evidence for bilateral inferior GH synovitis without bilateral SASD showed high specificity (94.7%) with sensitivity (78.9%) for the diagnosis of bilateral FS. SASD bursitis, representing periarticular synovial inflammation, was more common among the patients with PMR than among the patients with bilateral FS. Inferior GH synovitis without SASD bursitis suggests FS rather than PMR in patients with bilateral shoulder pain.

Magnetic resonance imaging of deltoid muscle/tendon tears: a descriptive study

To describe the MRI features of deltoid tears and to evaluate tear characteristics in patient groups based on history of trauma and rotator cuff tear (RCT). The records of patients who underwent shoulder MRI at our institution between July 2007 and June 2018 were retrospectively reviewed to identify deltoid tears, and patients were divided into groups based on history of recent trauma and presence of RCT. Images were reviewed to identify the location and size of the deltoid tear; the presence or absence of RCT, muscle atrophy, tendon retraction, humeral head subluxation, soft tissue edema, and additional pathologies were also noted. Medical records were reviewed for information about history of steroid injection, previous rotator cuff surgery, and treatments used. Among 69 patients with deltoid tears (45 men; mean age, 65.2years; range, 19-89years), patients with RCTs and no trauma had the highest frequency of deltoid tears in the middle portion (p = 0.005). Only patients with RCTs had undergone steroid injection or rotator cuff surgery. Two patients had deltoid tear without RCT and without recent trauma; these patients demonstrated evidence of calcific tendinopathy and chronic subacromial-subdeltoid bursitis. The middle (acromial) portion of the deltoid is more frequently affected in patients with RCTs than in those with trauma. Although deltoid tears are commonly associated with RCT, calcific tendinopathy and chronic bursitis may also be seen in patients with deltoid tears.

Ultrasound-guided musculoskeletal interventional procedures around the shoulder.

Ultrasound is a fast, accessible, reliable, and radiation-free imaging modality routinely used to assess the soft tissues around the shoulder. It enables to identify a wide range of pathological conditions. Furthermore, most ultrasound-guided musculoskeletal interventional procedures around the shoulder produce better results in terms of accuracy and clinical efficacy than those performed in a blinded fashion. Indeed, intra-articular and peri-articular interventional procedures can be easily performed under continuous ultrasound monitoring to ensure the correct position of the needle and to deliver the medication to a specific target. Several technical approaches and medications can be used to treat different causes of painful shoulder. Intra-articular injections are applied to treat acromioclavicular osteoarthritis as well as glenohumeral joint osteoarthritis and adhesive capsulitis. Subacromial-subdeltoid bursitis, either presenting as a primary inflammatory condition or secondary to rotator cuff disorders, can be easily approached using ultrasound guidance to aspirate synovial effusion and to inject medications. Ultrasound-guided percutaneous irrigation is a well-established technique increasingly applied to treat patients with rotator cuff calcific tendinopathy. Also, degenerative rotator cuff tendinopathy can be conservatively treated by image-guided interventions, specifically with needling under ultrasound guidance that can be associated with injections of platelet-rich plasma. Lastly, periarticular peripheral nerve block can be quickly and safely performed under ultrasound guidance, particularly in conditions involving the suprascapular nerve in the setting of pre-operative analgesia or pain treatment in glenohumeral osteoarthritis and adhesive capsulitis. In this article, the most common ultrasound-guided procedures around the shoulder have been reviewed to discuss indications and techniques.

Ultrasonography as diagnostic tool in rotator cuff injuries of shoulder

Introduction: Rotator Cuff injuries are quite common in adults with or without trauma. These are suspected on clinical history and examination and commonly confirmed by Ultrasonography and MRI of shoulder. This study aims to use Ultrasonography of shoulder as the main diagnostic tool for such injuries. Material and Methods: A total of 30 patients suspected to have complete or incomplete tear of Rotator Cuff were subjected to Clinical Examination of Shoulder including specific tests for Rotator Cuff Muscles, X-ray and Ultrasonography of shoulder. Diagnosis by clinical examination and Ultrasonography was compared. Observation and Results: Out of 30 cases studied, on clinical examination, 10 cases had complete tear of supraspinatus, 19 cases had incomplete tear of supraspinatus with or without subscapularis, and 1 case had isolated subscapularis tear. Ultrasonography noted full thickness tear of supraspinatus in 8 cases, incomplete tear of supraspinatus with or without subscapularis, in 20 cases, bicipital tendinitis in 01 case and subacromial subdeltoid bursitis in 01 case. Conclusion: Ultrasonography confirms the clinical diagnosis of rotator cuff tear with satisfactory sensitivity and specificity. It can be used as a first line diagnostic tool for diagnosis of Rotator cuff tear as it confirms the clinical suspicion and its results are comparable to MRI. Keywords: Rotator Cuff tear, Ultrasonogprahy, Shoulder.

Initial Experience of Office-based, Orthopaedic Surgeon Operated Ultrasonography of the Shoulder

OBJECTIVES: We present our initial experience of orthopaedic surgeon operated ultrasound examination as an extension of physical examination of the shoulder in our out-patient setting. MATERIALS AND METHODS: We retrieved information of all cases that underwent shoulder ultrasound examination in our out-patient clinic from June 2019 to Mar 2020. We reviewed the demography of the patients, their presenting symptoms and shoulder ultrasonographic findings. We also reviewed medical literature pertaining to accuracy of ultrasound detection of rotator cuff pathology, short learning curve for orthopaedic surgeons who are interested in acquiring proficiency in the use of ultrasound for shoulder examination, and increased accuracy of ultrasound guided therapeutic injections. RESULTS: We identified 90 patients who underwent out-patient clinic-based shoulder ultrasound examination. There were almost equally divided between males and females. Average age was 57 years. Pain was the most common chief complaint. We identified 12 different ultrasonographic pathologies in isolation or in combination. We describe the ultrasound findings in these pathologies. Most common ultrasonographic pathologies were subacromial-subdeltoid (SASD) bursitis and supraspinatus tendinitis or combination of both. Fifty-four ultrasound-guided therapeutic injections were performed. In our literature review we found overwhelming evidence for high accuracy for detection of rotator cuff pathology by orthopaedic surgeons, comparable to radiologists. There is also evidence of a shorter learning curve for orthopaedic surgeons interested in shoulder problems and for increased accuracy of therapeutic injections using ultrasound guide. CONCLUSION: We would like to encourage more orthopaedic surgeons to take up shoulder ultrasonography as part of their routine examination of shoulder problems and also consider integrating shoulder ultrasound training to the residency and fellowship training programs. The benefits to the patients include savings in time and money and also more accurate therapeutic injections when needed.

Sonographic Predictors in Patients with Hemiplegic Shoulder Pain: A Cross-Sectional Study

ObjectivesTo evaluate the sonographic findings of soft tissues more comprehensively, to investigate the relationship between sonographic pathologies and clinical features, and to determine the predicted factors that may interfere with the most common sonographic findings in patients with hemplegic shoulder pain (HSP) . MethodsSixty-four consecutive stroke patients with HSP admitted to inpatient clinic were included in this cross-sectional study. Demographic, clinical, and sonographic findings were recorded. Patients were assigned to poor or good motor function groups according to the Brunnstrom motor recovery (BMR) stages. ResultsThere were abnormal sonographic findings in 63 patients (98.4%). A significant reverse correlation was found between the sonographic grading and functional independence measure (p=0.005) and a positive correlation with energy level (p=0.044). The main risk factors were age for acromioclavicular joint degeneration, BMR stage for glenohumeral joint subluxation, subacromial-subdeltoid bursitis for partial-thickness rotator cuff tear, and Pittsburgh Sleep Quality Index for long head of the biceps tenosynovitis. ConclusionAge, motor recovery, subacromial-subdeltoid bursitis, and sleep quality were the strongest predictors of different sonographic findings in HSP patients. Functional capacity and energy level are negatively affected by an increased number of abnormal sonographic findings. Therefore, sonographic evaluation of shoulder soft tissue lesions eventually might provide a more constructive rehabilitation approach to achieve optimal outcomes, particularly in elderly patients with poor motor function and sleep quality.

Predictors of subclinical shoulder joint affection in patients with rheumatoid arthritis by ultrasonography

BackgroundTo assess subclinical involvement of shoulder joints in patients with rheumatoid arthritis (RA) by using musculoskeletal ultrasound (MSUS) and detect their predictors.ResultsWe found 75% of the patients have subclinical ultrasound changes in their shoulder joints where 65% of the patient’s shoulders are affected. About 57.5% of the shoulder joints showed peri-articular structural changes by ultrasound, while the articular changes were 36.9% with the most frequent one being supraspinatus tendinopathy (43.12%) followed by subacromial-subdeltoid bursitis [total (31.87%), effusion (16.87%), and synovial hypertrophy (15%)], supraspinatus tendon partial tear (30.62%), and long head of biceps tenosynovitis (effusion only) (28.75%), while the least frequencies were glenohumeral joint erosion (11.25%) and synovitis (12.5%). Older age and longer disease duration were significant predictors for the peri-articular changes with p value < 0.5, while high disease activity, seropositive rheumatoid factor, and long disease duration were significant predictors for the articular changes with p value < 0.5.ConclusionAlthough shoulders were clinically silent in RA patients, we found a high percentage of subclinical abnormalities detected by MSUS, which were more predominant in the peri-articular structures. MSUS is a simple and non-invasive technique that can be used to detect RA shoulder subclinical affection.