THE VALUE OF ULTRASOUND IN THE DIAGNOSIS OF SHOULDER PAIN

Sustavnim pregledom različitih izvora literature nastojalo se doći do zaključaka o vrijednosti ultrazvuka u dijagnostici bolnog ramena. Sindrom bolnog ramena uključuje čitav niz patoloških situacija poput rupture rotatorne manšete, subakromijalnog sraza, sindroma smrznutog ramena, kalcificiraućeg tenditisa, itd. Po prijavi bolnosti, pacijent se obično za početak podvrgava kliničkom pregledu pri čemu liječnik uzima detaljnu anamnezu. Nakon kliničke procjene obično je potrebno dijagnostičko snimanje. Jedna od često korištenih metoda u dijagnostici bolnog ramena je ultrazvuk, no kvaliteta same dijagnostike uvelike ovisi o znanju i sposobnostima liječnika ili tehničara koji pregled izvodi. Za razliku od CT, MRI i RTG dijagnostike, UZV se može provoditi u stanju mirovanja pacijenta s rukom u određenim položajima, u ovisnosti o dijelu ramene strukture koja se pregledava, ali i dinamički odnosno dok pacijent izvodi pokrete rukom. UZV je u širokoj primjeni kod dijagnostike mekanih struktura ramena, baš kao i MRI koji se još uvijek smatra glavnim alatom. Međutim, u usporedbi s ostalim metodama, UZV se pokazao bržim i dostupnijim rješenjem za pacijente jer ima izrazito nisku cijenu, nije invazivan, brzo se provodi i daje podatke u stvarnom vremenu. Najučinkovitiji se pokazao u procjeni površinskih tkiva, međutim, ne može prikazati unutarnje zglobne strukture. Koristi ga se u procjeni različitih patologija ramena, no najbolje rezultate pokazao je kod otkrivanja ruptura rotatorne manšete, kalcificirajućeg tendonitisa i potpune rupture tetive duge glave bicepsa, dok je, primjerice, za procjenu njezine parcijalne rupture osjetljivost ultrazvuka puno slabija u odnosu na MRI dijagnostiku.A systematic review of various literature sources led to conclusions about the value of ultrasound in the painful shoulder diagnosis. Painful shoulder syndrome includes a number of pathologies such as rotator cuff ruptures, subacromial collision, frozen shoulder syndrome, calcifying tenditis, etc. After reporting pain, the patient usually undergoes a clinical examination. Diagnostic imaging is usually required after clinical evaluation. One of the frequently used methods in the diagnosis of painful shoulder is ultrasound, but the quality of the diagnosis itself largely depends on the knowledge and skills of the technician who performs the examination. Unlike CT, MRI and X-ray diagnostics, ultrasound can be performed at rest of the patient with the hand in certain positions, depending on the part of the shoulder structure that is imaged, but also dynamically or while the patient performs hand movements. Ultrasound is widely used in the diagnosis of soft shoulder structures, just like MRI which is still considered the main tool. However, compared to other methods, ultrasound has proven to be a faster and more affordable solution for patients because it has an extremely low cost, it is not invasive, it is quickly implemented and provides real-time data. It has been shown to be most effective in assessing superficial tissues, however, it cannot show internal joint structures. It is used to assess various shoulder pathologies, but it has shown the best results in detecting rotator cuff ruptures, calcifying tendonitis, and complete rupture of the long biceps tendon, while, for example, to assess its partial rupture, ultrasound sensitivity is much lower than MRI diagnostics