Shoulder ultrasound (musculoskeletal imaging in primary care)

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

Notes:

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

Reference:

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