Sonographic study of painful shoulder

To identify sonographically the site and entity of alterations in a high number of patients with shoulder pain.

Two different experienced operators (both rheumatologists), who were blinded to the clinical data, performed sonographic examinations on 528 shoulders of 425 consecutive patients with painful shoulder and in both shoulders of 198 control subjects. They carried out ultrasound examinations separately using a 7.5 MHz linear transducer. Investigation included the long head of the biceps tendon, the supraspinatus tendon, infraspinatus tendon, subscapularis tendon, acromioclavicular joint, glenohumeral joint, subacromial-subdeltoid bursa, subscapularis bursa, and finally identification of calcifications. Before the ultrasonographic exam, a third experienced rheumatologist performed a physical examination in all patients using specific tests of movement for evaluation of the long head of biceps tendon, the supraspinatus tendon, infraspinatus tendon, subscapularis tendon, and acromioclavicular joint.

Sonographic alterations were found in a total of 94.1% of patients. The structure most frequently involved was the supraspinatus tendon (64.6%). The long head of the biceps tendon (48.1%) and the acromioclavicular joint (51.5%) were also frequently involved. Different types of alterations in the various structures were detected. Significant differences were found with respect to controls. A high sensitivity and specificity of sonography was demonstrated compared to physical examination.

Sonography evaluates accurately the single anatomic structures of the shoulder and identifies both the site and type of changes in patients with painful shoulder. The high sensitivity/specificity, non-invasiveness and low costs of this technique justify its routine utilisation in clinical rheumatological practice.