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Shoulder ultrasound (musculoskeletal imaging in primary care)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Shoulder ultrasound

  • in experienced hands ultrasound may be very accurate in the diagnosis of rotator cuff tears with sensitivity of over 90% for full thickness tear within 3 weeks of injury. Early cuff repair has a better prognosis

  • dynamic examination may show impingement often associated with subacromial bursitis. Some units offer ultrasound-guided injection of confirmed bursitis in a one-stop setting and ultrasound-guided needle barbotage of florid and severely symptomatic calcific tendinitis

  • synovitis, paralabral cysts and subcutaneous or intramuscular lipomas may also be diagnosed, as can acromioclavicular joint arthritis or subluxation

There are 'blind spots'for shoulder ultrasound

  • labral and proximal biceps tendon tears
  • frozen shoulder (clinical diagnosis)
  • bone marrow infiltrative disorders/metastases
  • glenohumeral OA
  • avascular necrosis


Ultrasound applications

  • Articular pain, swelling or mechanical symptoms without definitive diagnosis
  • Shoulder pain or mechanical symptoms
  • Symptoms near a joint
  • Regional neuropathic pain to diagnose neural entrapment
  • Guiding articular/periarticular aspiration or injection
  • Diagnosis and treatment assessment of synovitis

Ultrasound advantages

  • Cheaper, more accessible and better tolerated than MRI
  • Preferred modality for tendinopathy and muscle trauma
  • As accurate as MRI in diagnosis of rotator cuff tears
  • Dynamic examination and intervention possible


  • 1) Arthritis Research UK (Summer 2013). Hands on - Musculoskeletal imaging for GPs.

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.


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