498 THE JOURNAL OF BONE AND JOINT SURGERY Ultrasonography of the Rotator Cuff A COMPARISON OF ULTRASONOGRAPHIC AND ARTHROSCOPIC FINDINGS IN ONE HUNDRED CONSECUTIVE CASES*

Background: There has been limited acceptance of shoulder ultrasonography by orthopaedic surgeons in the United States. The purpose of this retrospective study was to determine the diagnostic performance of high-resolution ultrasonography compared with arthro-scopic examination for the detection and characteriza-tion of rotator cuff tears. Methods: One hundred consecutive shoulders in ninety-eight patients with shoulder pain who had un-dergone preoperative ultrasonography and subsequent arthroscopy were identified. The arthroscopic diagnosis was a full-thickness rotator cuff tear in sixty-five shoul-ders, a partial-thickness tear in fifteen, rotator cuff ten-dinitis in twelve, frozen shoulder in four, arthrosis of the acromioclavicular joint in two, and a superior labral tear and calcific bursitis in one shoulder each. All ultra-sonographic reports were reviewed for the presence or absence of a rotator cuff tear and a biceps tendon rup-ture or dislocation. All arthroscopic examinations were performed according to a standardized operative proce-dure. The size and extent of the tear and the status of the biceps tendon were recorded for all shoulders. The findings on ultrasonography and arthroscopy then were compared for each parameter. Results: Ultrasonography correctly identified all sixty-five full-thickness rotator cuff tears (a sensitivity of 100 percent). There were seventeen true-negative and three false-positive ultrasonograms (a specificity of 85 percent). The overall accuracy was 96 percent. The size of the tear on transverse measurement was cor-rectly predicted in 86 percent of the shoulders with a full-thickness tear. Ultrasonography detected a tear in ten of fifteen shoulders with a partial-thickness tear that was diagnosed on arthroscopy. Five of six disloca-tions and seven of eleven ruptures of the biceps tendon were identified correctly