Sonographic detection of tears of the anterior portion of the rotator cuff (subscapularis tendon tears).

Abstract

We studied the value of ultrasonography in identifying tears of the most anterior portion of the rotator cuff (subscapularis tendon tears). Shoulder sonography was performed on 1640 patients with shoulder symptoms, 435 of whom underwent surgery. Among the patients who were operated on, 17 had predominantly or exclusively subscapularis tendon tears; 14 of these were full-thickness and three were partialthickness tears. Ultrasonography demonstrated 82% T he rotator cuff has tendency to tear near the insertion of the supraspinatus tendon as a consequence of its lesser degree of vascularization or because of age-related changes and mechanical trauma.l Tears of the subscapularis tendon are uncommon. They are rarely found in isolation, except after severe trauma.2 Subscapularis tendon tears are found more commonly in elderly patients with recurrent shoulder dislocation or in patients with massive cuff tears) · Various clinical studies have correlated sonographic findings of rotator cuff tears to findings of open surgical procedure or arthroscopy4-7 as well as arthrographyB.9 in detecting rotator cuff tears.However, as yet, no reports have compared the sonographic findings of subscapularis tendon tears with results of surgery, arthroscopy, or arthrography. Accordingly, the aims of this study are to describe Receiwd March 13, 1995, (14 of 17) of the subscapularis tendon tears; 86% (12 of 14) of the full -thickness tears and 67% (2 of 3) of the partial-thickness tears were correctly diagnosed with ultrasonography. Sonography can diagnose and show the size of subscapularis tendon tears reliably, but it necessitates that the arm can be externally rotated to the maximum extent ~hen performing the study. KEY WORDS: Subscapulans tendon; Tears, tendon; Shoulder; Rotator cuff. the appropriate technique for the ultrasonographic evaluation of the subscapularis tendon and to discuss the reliability and restrictions of ultrasonography in the diagnosis of subscapularis tendon tears in 17 patients with surgical confirmation. PATIENTS AND METHODSFrom 1986 to 1994, 1640 patients with painful shoulder underwent bilateral shoulder sonography. Of these, 241 men and 194 women 22 to 77 years old (mean, 51 years) required surgical management. Of the 435 patients who underwent surgery, 17 had surgically confirmed tears of the subscapularis tendon. The sonographic findings in this group (11 men and six women, 34 to 58 years old; mean age, 48 years) were analyzed. The orthopedic surgeons were aware of the findings of sonography prior to surgery.All sonograms were obtained and interpreted prospectively by one radiologist (P.U.F.). The sanagrams were obtained with four different types of equipment with 7.5 MHz linear array transducers (Aloka SSD-280 LS, Aloka 650, Aloka 2000, Tokyo,

Ultrasound vs. MRI in the assessment of rotator cuff structure prior to shoulder arthroplasty

“…They further differentiated between partial-and full-thickness tears and assessed sensitivities of only 67% and 86% for the latter ones. 19 In our study 75.6% of the ruptures diagnosed in US could be observed intraoperatively. These results once more demonstrate a low accuracy for detection of partial-thickness tears in US.…”

“…18,19 Farin et al described similar results in patients with ongoing shoulder pain. They were able to detect 82% of the subscapularis tendon ruptures preoperatively in US.…”

“…For the US-evaluation of the subscapularis tendon, it is essential to externally rotate to a maximum and visualize the tendon under traction. 19 Patients with osteoarthritis usually suffer from an impaired or even lost ability to externally rotate. Even more, a medialization of the humeral head is often present so that the interval of the subscapularis between the coracoid process and the lesser tuberosity is diminished.…”

Sonography of the Coracohumeral Interval

“…Additionally, sonography provides the benefits of dynamic real-time evaluation of the subcoracoid recess as well as a method for accurately delivering diagnostic injections to the affected site. Sonography can also evaluate associated findings, such as abnormalities in the subscapularis tendon, 21 although this was not a focus of our study. We were able to consistently show a significant difference between the CHI in normal asymptomatic shoulders and the CHI in shoulders with symptoms consistent with coracoid impinge ment.…”

Integrity and function of the subscapularis after total shoulder arthroplasty

“…The integrity of the subscapularis was evaluated in both longitudinal and transverse images utilizing previously published techniques. 5,[19][20][21] All examinations were performed with a 14-7 MHz linear array transducer, incorporating dynamic internal and external rotation and isometric muscle contractions as necessary. Contralateral comparative views were obtained in all patients.…”