Elasticity of torn supraspinatus tendons measured by shear wave elastography: a potential surrogate marker of chronicity?

Abstract

Purpose: This study investigated whether shear wave elastography (SWE) could be used to estimate the chronicity of supraspinatus tendon (SST) tears. Methods: A retrospective study was performed. From November 2015 to July 2016, 113 patients (52 men, 61 women; age range, 21 to 79 years) with persistent shoulder pain underwent 119 rotator cuff tendon examinations by routine B-mode ultrasonography, while SST elasticity was measured using SWE. Following the exclusion of eight suboptimal examinations, four examinations with missing SST measurements, and 27 examinations of patients with other conditions, 80 examinations were analyzed. A torn SST was found in 54 examinations (27 with a partial-thickness tear and 27 with a full-thickness tear). Elasticity values were compared in multiple ways. The results were analyzed using the Mann-Whitney U test or Kruskal-Wallis test. Results: No statistically significant difference in elasticity values (in kPa) was found between normal (median, 94.65; interquartile range [IQR], 87.43 to 105.47) and torn SSTs (median, 96.79; IQR, 86.71 to 108.56) or between full-thickness tears (median, 93.80; IQR, 82.50 to 108.33) and partial-thickness tears (median, 96.83; IQR, 90.60 to 112.20). However, there was a statistically significant difference in elasticity according to whether the duration of symptoms was 1 year or less (median, 92.20; IQR, 84.01 to 104.38) or longer than 1 year (median, 105.10; IQR, 100.41 to 116.03; P=0.032). Conclusion: Elasticity values were significantly higher in torn SSTs in patients with chronic shoulder pain that had persisted for more than 1 year. Further studies with larger samples seem warranted to determine whether elasticity values measured by SWE can be used preoperatively as a surrogate marker of the chronicity of a rotator cuff tendon tear.

Evaluation of the ulnar nerve with shear-wave elastography: a potential sonographic method for the diagnosis of ulnar neuropathy

“…Ultrasound imaging in particular supports the diagnosis of neuropathy by providing superior spatial resolution of small peripheral nerves and detailed information regarding lesion localization [6]. Moreover, as a recently-developed ultrasound imaging technology, shear-wave elastography (SWE) has the potential to provide quantitative values for the soft tissue stiffness of tissues, including the muscle [7], tendon [8], joint capsule [9], benign soft tissue mass [10], and nerves, and to improve the diagnostic performance of ultrasound imaging for various neuropathies involving the median, sciatic, tibial, and ulnar nerves [11][12][13][14][15]. The aim of this study was to verify whether cubital tunnel syndrome can be diagnosed based on quantitative ulnar nerve stiffness data obtained with SWE, as well as to compare patients with ulnar neuropathy to those with medial epicondylitis and lateral epicondylitis to establish a precise cut-off value of this parameter for use in ultrasound imaging.…”

Tissue predictability of elastography is low in collagenase induced deep digital flexor tendinopathy

“…A meta‐analysis revealed that no significant difference in elastographically estimated tendon elasticity or strain ratio could be identified between shoulders with and without rotator cuff tendinopathy 17 . Similarly, no significant difference in elasticity values were found between normal and torn supraspinatous tendons, despite authors noting that elasticity differences were significant according to whether symptoms were one year in duration or less 18 . When strain ratios and functional scores were compared in patients with subacromial impingement syndrome, no significant correlation was found 19 .…”

“…Elastography and its ability to predict physiologic tissue characteristics have been a source of ongoing interest in human tendinopathic imaging 17–19 . Previous authors have noted that imaging modalities’ diagnostic capability must be great enough to detect deformability differences between normal and diseased tissues 1,20 .…”

“…Previous authors have noted that imaging modalities’ diagnostic capability must be great enough to detect deformability differences between normal and diseased tissues 1,20 . Despite its increasing popularity due to consistent image reproducibility among observers, 21 non‐invasiveness, and its potential to longitudinally monitor tendon healing through tissue stiffness estimation, elastographic measures have inconsistently demonstrated measurement distinctions between healthy and diseased soft tissues 17–19 . A meta‐analysis revealed that no significant difference in elastographically estimated tendon elasticity or strain ratio could be identified between shoulders with and without rotator cuff tendinopathy 17 .…”

Sonoelastography of the Shoulder: A Narrative Review

“…Another study showed increased stiffness in LHBT in tendinosis conditions (1,2). In postsurgical status after supraspinatus tendon repair, SWE seems to show different short-term and long-term results concerning two newly published articles (8,11). In previously published papers, there are controversies for SE changes (hardness vs. softness) of supraspinatus tendinopathic conditions.…”