Background: Controversy exists regarding how much external rotation should be allowed following rotator cuff repair. Clinicians may use ultrasound imaging (USI) to visualize the supraspinatus (SSp) tendon during passive external rotation. However, the validity and reliability of USI used to assess supraspinatus tendon gap formation during external rotation needs to be established prior to using this technique in patient cohorts. Methods: Ten subjects with magnetic resonance imaging (MRI) confirmation of full-thickness SSp tears were matched to 10 control subjects. Images of the SSp were obtained at 0 , 10 , 20 and 30 of external rotation by a blinded tester on two occasions to establish both validity and reliability of the measure. Results: Validity was established as 70% agreement between the USI and MRI confirmed SSp tear group; reliability was established at greater than 0.90 at all positions of external rotation measured. Conclusions: USI may be used to detect SSp tears with 70% validity, and the technique is reliable in all positions of external rotation.

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