This study is both a retrospective and prospective evaluation of the clinical usefulness of shoulder sonography. Ninety-eight patients suspected of having rotator cuff tears underwent sonography of both shoulders. Sixty-two patients underwent double-contrast arthrography performed on the same day as sonography, and 38 patients underwent surgery after sonography. A comparison of the results from ultrasound and arthrography, using published diagnostic criteria, demonstrated a sensitivity of 75% and a specificity of 43% for detection of a rotator cuff tear. In this study, use of more restricted criteria, a subset of the published criteria, yielded a sensitivity of 68% and a specificity of 90%. A comparison of sonography with surgery, using this study's criteria, demonstrated a sensitivity of 57% and a specificity of 76%. This report shows that shoulder sonography is less reliable than previously reported and appears to have a very limited role in the evaluation of rotator cuff injuries.

Snapping biceps femoris is a rare phenomenon in which the biceps femoris tendon subluxates over the fibular head when the leg is brought into deep flexion. Two primary pathologies have been identified: biceps insertion tears/anatomic variants and/or an enlarged fibular head. Often, it can be treated nonoperatively; however, if symptoms are severe enough and refractory to conservative treatments, the underlying pathology can be corrected surgically to alleviate symptoms. The diagnosis is made clinically; the subluxation should be reproducible with deep flexion and should abate with manual compression of the biceps muscle and internal rotation of the tibia. Radiographs can help to discern the size and shape of the fibular head, and magnetic resonance imaging can often help to determine any abnormal tendon insertions. The surgeon should be comfortable with the anatomy of the lateral knee. It is critical to protect the common peroneal nerve. With the appropriate correction, the subluxation can be eliminated and symptoms dramatically improved.

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