[Role of ultrasonography in the diagnosis of shoulder joint injury].

PURPOSE OF THE STUDY To define the role of ultrasonography in the diagnostic algorithm for patients with shoulder joint injury and to show its potential for the detection of rotator cuff tears and Hill-Sachs lesions. MATERIAL AND METHODS A group of 52 patients with clinical signs of shoulder disorders following trauma who were treated in the 2005-2006 period. After ultrasonographic examination, all patients were surgically treated by arthroscopy. In 12 of them an additional magnetic resonance imaging was carried out before surgery. The results of ultrasonography were compared with arthroscopic findings in terms of detection of full-thickness rotator cuff tears and Hill-Sachs lesions. These were the two most frequent traumatic lesions detected by ultrasonography. RESULTS A full-thickness tear of the rotator cuff was correctly diagnosed in 13 patients. In further four the ultrasound finding was incorrectly interpreted as a moderate rotator cuff injury. For the detection of full-thickness tears, the sensitivity of the method was 76 %, its specificity was 94 % and accuracy 88 %. The detection of Hill-Sachs lesions by ultrasonography correlated with arthroscopic findings, with a sensitivity of 86 %, specificity of 93 % and accuracy of 92 %. DISCUSSION A number of studies report on options for the ultrasonographic detection of various types of traumatic injury to shoulder structures. Examination by ultrasound shows skeletal surfaces, thus permitting detection of a minor bone injury or a Hill- Sachs defect, and reveals soft tissue shoulder structures including tendons, ligaments and bursae. In some studies the possibility of detecting rotator cuff tears by ultrasonography has been described. Although sufficient accuracy of ultrasonographic examination in this region is reported, the results are not consistent. CONCLUSIONS Our results show high reliability of ultrasonography for the diagnosis of shoulder trauma. The detection of full-thickness rotator cuff tears and Hill-Sachs lesions was possible with sufficient accuracy, which makes this quick, simple and available examination a valuable diagnostic tool. The finding of a rotator cuff tear is important information for the orthopaedist and, in the majority of patients, is also an indication for surgery. An ultrasonographic examination can therefore be regarded as a standard part of the diagnostic algorithm for shoulder trauma.

[1]  J. Jerosch,et al.  [Sonographic diagnosis of Hill-Sachs lesions in unstable shoulder joints]. , 2008, Ultraschall in der Medizin.

[2]  D. Musil,et al.  [Massive tears of the rotator cuff--comparison of mini-open and arthroscopic techniques. Part 2. Arthroscopic repair]. , 2007, Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca.

[3]  M. Pach,et al.  [The role of capsulolabral complex in Bankart lesion repair using Mitek anchors]. , 2007, Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca.

[4]  W. Palmer,et al.  Shoulder magnetic resonance imaging. , 2006, Clinics in sports medicine.

[5]  J. Stehlík,et al.  [Arthroscopic stabilization of the shoulder]. , 2006, Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca.

[6]  M. Vykydal.  Syndrom bolestivého ramene , 2005 .

[7]  J. Milosavljević,et al.  Ultrasonography of the rotator cuff: a comparison with arthroscopy in one-hundred-and-ninety consecutive cases , 2005, Acta radiologica.

[8]  R. Pozzi Mucelli,et al.  Standard sonography and arthrosonography in the study of rotator cuff tears. , 2005, La Radiologia medica.

[9]  E. Mcnally,et al.  Practical Musculoskeletal Ultrasound , 2004 .

[10]  S. Koskinen,et al.  Multidetector CT in shoulder fractures , 2004, Emergency Radiology.

[11]  Katsumasa Sugimoto.  Ultrasonographic evaluation of the Bankart lesion. , 2004, Journal of shoulder and elbow surgery.

[12]  W. Walsh,et al.  Role of community diagnostic ultrasound examination in the diagnosis of full‐thickness rotator cuff tears , 2003, ANZ journal of surgery.

[13]  S. Larsson,et al.  Role of us in the preoperative evaluation of patients with anterior shoulder instability. , 2001, Radiology.

[14]  C. Roberts,et al.  Diagnostic capabilities of shoulder ultrasonography in the detection of complete and partial rotator cuff tears. , 2001, American journal of orthopedics.

[15]  K. Yamaguchi,et al.  Ultrasonography of the Rotator Cuff: A Comparison of Ultrasonographic and Arthroscopic Findings in One Hundred Consecutive Cases* , 2000, The Journal of bone and joint surgery. American volume.

[16]  C. Spettell,et al.  Internal derangements of the shoulder: decision tree and cost-effectiveness analysis of conventional arthrography, conventional MRI, and MR arthrography , 1999, Skeletal Radiology.

[17]  D. Resnick,et al.  Imaging findings in the dominant shoulder of throwing athletes: comparison of radiography, arthrography, CT arthrography, and MR arthrography with arthroscopic correlation. , 1999, AJR. American journal of roentgenology.

[18]  R. Bilić,et al.  Hill‐Sachs lesion in recurrent shoulder dislocation: sonographic detection. , 1998, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[19]  U. Väätäinen,et al.  Hill-Sachs lesion: sonographic detection , 1996, Skeletal Radiology.

[20]  R. Chaloupka,et al.  Artroskopická přední stabilizace ramene a fyzioterapie. , 2006 .

[21]  A. Armstrong,et al.  The efficacy of ultrasound in the diagnosis of long head of the biceps tendon pathology. , 2006, Journal of shoulder and elbow surgery.

[22]  R. Patten,et al.  Nondisplaced fractures of the greater tuberosity of the humerus: sonographic detection. , 1992, Radiology.

[23]  E. Roberts.  Brain and behavior: 3. Some aspects of the biochemistry and physiology of gamma aminobutyric acid in the central nervous system. , 1960, The American journal of orthopsychiatry.