Ultrasound examination in shoulder pain: an analysis of 300 patients

Aim of the study: to evaluate patients with shoulder pain using ultrasound (US) techinque. Materials and Methods: US exams were performed using a Toshiba Power Vision 6000 US machine, with a linear multifrequency (8-15 MHz) probe. We have examined: 1) rotator cuff tendons (supraspinatus, infraspinatus, subscapolaris); 2) long head of the biceps (LHB) tendon; 3) subdeltoid-subacromial bursa; 4) subscapolaris bursa; 5) gleno-humeral joint; 6) acromion-clavicular jont. All the exams were done (between the year 2003 and 2004) by a rheumatologist expert in musculoskeletal US. A total of 294 consecutively patients affering to the Reumatology Unit of the University of Pisa for shoulder pain were studied (87 males, 207 females), average was 61±13 years (range 25-82); only the 31.6 of them were affected by inflammatory or degenerative rheumatic diseases, while the 68.4 claimed shoulder pain without defined rheumatic disorder. Results: rotator cuff tear was present in 141 subjects, LHB tendon tear in 21, cortical bone erosions of the humeral head in 28, acromion-clavicular synovitis in 52, acromion-clavicular osteoarthritis in 62, bursitis (subdeltoid-subacromial or subscapolaris) in 112, LHB tenosynovitis without the coexistance of other abnormalities (respect to the 183 tenosynovitis showed) in 81. A supraspinatus tendon tear (complete, partial, mono- or bilateral) was present in 139 patients, and in 10 subjects was present an associated infraspinatus tendon tear, as it was for the subscapolaris tendon tear. All the 21 LHB tendon tears were present in patients with a rotator cuff tear. Only 16 of the 52 acromion-clavicular synovitis where present in the absence of a rotator cuff tendon tear. Acromion-clavicular osteoarthritis was the only abnormal findings in 11 patients. Only 10 out of the 112 bursitis were not associated to other abnormalities, the others were present in patients with LHB tenosynovitis (18 subjects) and in rotator cuff tendon tear (84 subjects). Conclusion: our preliminar data show the high prevalence of rotator cuff tendon tear in subjects with shoulder pain (even in the controlateral shoulder). Basing on these data we raccomend: 1) to perform, as first-line imaging tecnique, US evaluation in subjects with acute onset of shoulder pain, most of all before the decision of the treatment (i.e. steroid injection); 2) to perform US exam in patients with a chronic shoulder pain with a recent exacerbation and, finally, to study with US all the subjects ³65 years old because of the high frequency of tendon tears (62,4) in those particular age subclassis