Ultrasonography Outperforms Magnetic Resonance Imaging in Diagnosing Partial-Thickness Subscapularis Tear

Zhu, Sizheng; Pu, Darong; Li, Jia; Wu, Dandong; Huang, Wei; Hu, Ning; Chen, Hong

doi:10.1016/j.arthro.2021.07.015

Cited by 12 publications

(10 citation statements)

References 31 publications

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“…In comparison to 14 studies which revealed 80% sensitivity and 95% specificity for partial thickness tear. This contradicts the findings of 17 , which found that dynamic ultrasonography had a high sensitivity (about 100%) for detecting various kinds of partialthickness rotator cuff injuries. In comparison to 18 studies found that ultrasound and magnetic resonance imaging were equally effective in identifying full-thickness rotator cuff injuries.…”

Section: Discussioncontrasting

confidence: 73%

Comparative study of Ultrasound and MRI in diagnosis and assessment of shoulder impingement syndrome

Abbass

Fahim

Ibrahim

2022

Al-Azhar International Medical Journal

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Background: When the arm sometimes lifted, the rotator cuff, subacromial bursa, and biceps tendon pressed on the underside of the acromion and coracoacromial ligament, causing shoulder impingement. There are two sorts of impingements: intrinsic and extrinsic. As a result of the degenerative process brought on by excessive strain, intrinsic impingement produces a partial or full rupture of the rotator cuff tendons. Extrinsic impingement occurs when outside causes apply mechanical pressure on the tendons, causing irritation or degeneration. Aim of The Work: Using MR imaging as a gold standard, assess and compare the effectiveness of high-resolution ultrasonography and magnetic resonance imaging in identifying subacromial impingement disorders.Patients and Methods: The study has been carried out on 50 patients, based on age range 20-60 years, having pain at the shoulder for three months and more with a clinically confirmed diagnosis of subacromial impingement, excluding cases having a history of shoulder dislocation, fractures, surgical intervention, or neoplastic lesions. All patients had ultrasonography and conventional MR exams. Results: Intrinsic impingement reasons were more common in patients under the age of 40. Those above the age of 40, on the other hand, showed a greater incidence of extrinsic factors, particularly hypertrophic osteoarthritic changes of the acromioclavicular joint, with full-thickness rotator cuff tendon tears. Conclusion: Ultrasonography was proven to be a fairly sensitive diagnostic technique for subacromial impingement in this study.

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Section: Discussioncontrasting

confidence: 73%

Comparative study of Ultrasound and MRI in diagnosis and assessment of shoulder impingement syndrome

Abbass

Fahim

Ibrahim

2022

Al-Azhar International Medical Journal

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“…However, ultrasound has been verified to be equivalent or even superior to MRI in evaluating rotator cuff tears. 12 , 46 The postoperative healing status of only the SSC tendon was assessed; ultrasound was not used to evaluate the final status of the other supraspinatus and infraspinatus tendons. During the follow-up period, new tears may have developed, extending into the other cuff tendons (supraspinatus and infraspinatus), potentially influencing the study results.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…26,40 This suggests that while the skill and experience of the evaluator can play a role in the accuracy of the results, ultrasound remains a reliable method for assessing rotator cuff tears because of its consistent findings among different observers. 11,46 CONCLUSION AISR improves clinical outcomes and results in an overall high rate of tendon healing at a mean midterm followup. Smaller tear sizes with less muscle atrophy are correlated with improved tendon healing.…”

Section: Limitationsmentioning

confidence: 95%

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Clinical Outcomes and Tendon Healing After Arthroscopic Isolated Subscapularis Tendon Repair: Results at Midterm Follow-up

Kilic,

Zuk,

Ardebol

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Few studies have reported clinical outcomes and tendon healing rates after arthroscopic isolated subscapularis (SSC) repair (AISR). Purpose/Hypothesis: The primary purpose of this study was to evaluate clinical outcomes and tendon healing after AISR. It was hypothesized that AISR would result in satisfactory clinical outcomes along with a high rate of tendon healing at the midterm follow-up. The secondary purpose was to assess the influence of tear size and muscle atrophy on SSC tendon healing and patient-reported outcomes. It was hypothesized that both would be negatively correlated with healing but would have no effect on clinical outcomes . Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was conducted on prospectively collected data for 77 patients who underwent primary AISR between 2011 and 2021 at a single institution, with a minimum 2-year postoperative follow-up for all patients. Functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Subjective Shoulder Value (SSV), and the visual analog scale for pain. Repair techniques and concomitant procedures were also collected. SSC tendon healing was evaluated via ultrasound at the final follow-up. Linear regression analysis was performed to determine factors affecting SSC healing. Results: The mean follow-up was 58.1 ± 3.3 months. ASES scores significantly improved from 41.5 to 81.6, and the SSV improved from 38.2 to 80.5 ( P < .01 for both). Among the 40 patients (51.9%) who underwent postoperative ultrasound, 87.5% showed complete tendon healing. There were no significant differences in outcome scores between healed and unhealed tendons. Increased muscle atrophy and larger tears were correlated with failure of SSC healing (β = −0.285 [ P = .015] and β = −0.157 [ P = .045], respectively). Conclusion: Improved clinical outcomes and an overall high rate of tendon healing were seen at the midterm follow-up after AISR. Smaller tear sizes with less muscle atrophy were correlated with improved tendon healing. However, even when the tendon incompletely healed, the procedure improved functional outcomes.

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“…However, Fujiwara et al (2022) suggest the position of LHBT on pre-operative ultrasound can be used to predict the presence of intra-operative subscapularis tears [ 15 ]. As a dynamic imaging modality, we suppose that ultrasound may be more useful than static imaging, as recently illustrated by Zhu et al (2022), who found ultrasound to be superior to MRI in diagnosing partial-thickness subscapularis tears [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Is It Time to Rethink the Relationship Between Subscapularis Tears and the Long Head of Biceps Tendon?

Prakash,

Dekker,

Modi

et al. 2024

Cureus

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Introduction Pre-operative diagnosis of subscapularis tears remains a difficult challenge. Ultrasound has been shown to be ineffective at directly detecting subscapularis tears. It has been widely accepted that medial subluxation of the long head of biceps tendon (LHBT) is associated with full-thickness subscapularis tears. The aims of this study are to assess whether LHBT subluxation on ultrasound scanning has any predictive value for subscapularis tears and to determine the relationship between LHBT subluxation and subscapularis tears at arthroscopy. Methods Pre-operative ultrasound and arthroscopic findings for patients undergoing arthroscopic rotator cuff repair at our institution between March 2011 and January 2016 were analysed. The accuracy of LHBT subluxation on ultrasound and at arthroscopy as a predictor of subscapularis tears at arthroscopy was calculated. The correlation between LHBT subluxation and subscapularis tears was determined. A standardised technique was used for ultrasound scans, and the grade of the sonographer was recorded. Results Three hundred fifty-nine rotator cuff repairs were performed. Twenty-four patients had a subluxed LHBT. Ultrasound was poorly sensitive (50%), and a subluxed LHBT on ultrasound only correlated very weakly with subscapularis tears at arthroscopy (R = 0.268, p<0.001). At arthroscopy, 92 patients had full-thickness subscapularis tears. Of these, only 16 patients (17%) had a subluxed/dislocated LHBT. Of the 24 patients with a subluxed LHBT, eight had no subscapularis tears. Thus, LHBT subluxation/dislocation only correlated weakly with full-thickness subscapularis tears (R=0.252, p<0.001). Conclusion Due to their close anatomical relationship, traditional teaching suggests subscapularis tears are associated with medial LHBT subluxation. Our data indicate that, contrary to popular belief, the two are only weakly correlated. In our series, the majority of patients with subscapularis tears (83%) had their LHBT in-groove. The authors therefore recommend high vigilance during arthroscopy for the diagnosis and repair of subscapularis tears, regardless of pre-operative ultrasound findings and the intra-operative position of the LHBT.

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Ultrasonography Outperforms Magnetic Resonance Imaging in Diagnosing Partial-Thickness Subscapularis Tear

Cited by 12 publications

References 31 publications

Comparative study of Ultrasound and MRI in diagnosis and assessment of shoulder impingement syndrome

Comparative study of Ultrasound and MRI in diagnosis and assessment of shoulder impingement syndrome

Clinical Outcomes and Tendon Healing After Arthroscopic Isolated Subscapularis Tendon Repair: Results at Midterm Follow-up

Is It Time to Rethink the Relationship Between Subscapularis Tears and the Long Head of Biceps Tendon?

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