SONOGRAPHY : A VALUABLE MODALITY IN EVALUATION OF CHRONIC NON-TRAUMATIC DISORDERS OF THE SHOULDER JOINT

Chronic non-traumatic shoulder pain may be due to arthralgia, shoulder myalgia, glenohumeral synovitis, adhesive capsulitis, or degenerative joint disease. Clinical skills and routine radiography may not be adequate to establish the diagnosis. This study was designed to assess the role of sonography in such a setting. Twenty-six consecutive patients attending the clinical immunology outpatient department for chronic shoulder pain were evaluated. Based on our findings, we have described 4 distinct sonographic patterns. Pattern 1 consisted of the normal sonographic appearance with semicircular smooth humeral head profile parallel to which was an echo-free synovial space measuring 1-2 mm. This pattern indicated shoulder arthralgia or myalgia without intrinsic shoulder joint disease. Pattern 2 consisted of reduction in the echo-free space indicative of adhesive capsulitis. Pattern 3 consisted of uniform increase in this space, thus indicating active synovial inflammation with effusion. Pattern 4 showed irregularity of the humeral head with reduction in the gleno-humeral joint space and loss of parallelism between the humeral head and the surrounding gleno-humeral synovial space. This last pattern indicated advanced deformed inflammatory or degenerative arthritis. It is concluded that these 4 sonographic patterns will be of considerable help in pinpointing the diagnosis in cases of chronic non-trumatic shoulder pain.