SEARCH WITHIN CONTENT
Citation Information : Journal of Ultrasonography. Volume 15, Issue 60, Pages 29-44, DOI: https://doi.org/10.15557/JoU.2015.0003
License : (CC BY-NC-ND 4.0)
Received Date : 07-September-2014 / Accepted: 05-December-2014 / Published Online: 13-September-2016
Objective: High resolution ultrasonography is a non-painful and non-invasive imaging technique which is useful for the assessment of shoulder pain causes, as clinical
examination often does not allow an exact diagnosis. The aim of this study was to compare the fi ndings of clinical examination and high resolution ultrasonography
in patients presenting with painful shoulder. Methods: Non-interventional observational study of 100 adult patients suffering from unilateral shoulder pain. Exclusion
criteria were shoulder fractures, prior shoulder joint surgery and shoulder injections in the past month. The physicians performing the most common clinical shoulder
examinations were blinded to the results of the high resolution ultrasonography and vice versa. Results: In order to detect pathology of the m. supraspinatus tendon, the
Hawkins and Kennedy impingement test showed the highest sensitivity (0.86) whereas the Jobe supraspinatus test showed the highest specifi city (0.55). To identify m. subscapularis tendon pathology the Gerber lift off test showed a sensitivity of 1, whereas the belly press test showed the higher specifi city (0.72). The infraspinatus test showed a high sensitivity (0.90) and specifi city (0.74). All AC tests (painful arc IIa, AC joint tendernessb, cross body adduction stress testc) showed high specifi cities (a0.96, b0.99, c0.96). Evaluating the long biceps tendon, the palm up test showed the highest sensitivity (0.47) and the Yergason test the highest specifi city (0.88). Conclusion: Knowledge of sensitivity and specifi city of various clinical tests is important for the interpretation of clinical examination test results. High resolution ultrasonography is needed in most cases to establish a clear diagnosis.
1. Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M et al.:Estimating the burden of musculoskeletal disorders in the community:the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis 1998; 57: 649–655.
2. Chard MD, Hazleman R, Hazleman BL, King RH, Reiss BB: Shoulder disorders in the elderly: a community survey. Arthritis Rheum 1991; 34: 766–769.
3. McCormick A, Fleming D, Charlton J; Royal College of General Practitioners; Great Britain. Offi ce of Population Censuses and Surveys; Great Britain. Department of Health and Social Security: Morbidity statistics from general practice: fourth national study 1991–1992. London: HMSO; 1996.
4. Jones JR, Hodgson JT, Clegg TA, Elliott RC: Self-reported work-related illness in 1995. Norwich: HMSO; 1998.
5. Croft P, Pope D, Silman A. The clinical course of shoulder pain: prospective cohort study in primary care. Primary Care Rheumatology Society Shoulder Study Group. BMJ 1996; 313: 601–602.
6. Winters JC, Sobel JS, Groenier KH, Arendzen JH, Meyboom de Jong B: The long-term course of shoulder complaints: a prospective study in general practice. Rheumatology 1999; 38: 160–163.
7. Vecchio PC, Kavanagh RT, Hazleman BL, King RH: Community survey of shoulder disorders in the elderly to assess the natural history and effects of treatment. Ann Rheum Dis 1995; 54: 152–154.
8. Dalton SE: The shoulder. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (eds.): Rheumatology. Mosby Elsevier, Philadelphia (PA) 2011. 9. Naredo E, Aguado P, De Miguel E, Uson J, Mayordomo L, Gijon-Baños
J et al.: Painful shoulder: comparison of physical examination and ultrasonographic fi ndings. Ann Rheum Dis 2002; 61: 132–136. 10. Iagnocco A, Coari G, Leone A, Valesini G: Sonographic study of painful shoulder. Clin Exp Rheumatol 2003; 21: 355–358.
11. Dietschi A, Schwarzenbach HR: Der Ultraschall am Bewegungsapparat – Moglichkeiten und Grenzen. Praxis 2012; 101: 1193–1195.
12. Ultraschall Schulter: http://www.locomo.ch/administration/Ultraschall% 20Schulter.Pathologie.pdf. 13. European Society of Musculoskeletal Radiology: http://www.essr.org/cms/website.php?id=/en/index/educational_material.htm.
14. Backhaus M, Burmester GR, Gerber T, Grassi W, Machold KP, Swen WA et al.: Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 2001; 60: 641–649.
15. Buckup K, Buckup J: Klinische Tests an Knochen, Gelenken und Muskeln:Untersuchungen – Zeichen – Phänomene. Georg Thieme Verlag KG, Stuttgart 2012.
16. Yablon CM, Bedi A, Morag Y, Jacobson JA: Ultrasonography of the shoulder with arthroscopic correlation. Clin Sports Med 2013; 32: 391–408.
17. Nelson MC, Leather GP, Nirschl RP, Pettrone FA, Freedman MT: Evaluation of the painful shoulder. A prospective comparison of magnetic resonance imaging, computerized tomographic arthrography, ultrasonography, and operative findings. J Bone Joint Surg Am 1991; 73: 707–716.
18. Read JW, Perko M: Shoulder ultrasound: diagnostic accuracy for impingement syndrome, rotator cuff tear, and biceps tendon pathology. J Shoulder Elbow Surg 1998; 7: 264–271.
19. Scheel AK, Schmidt WA, Hermann KG, Bruyn GA, D’Agostino MA, Grassi W et al.: Interobserver reliability of rheumatologists performing musculoskeletal ultrasonography: results from a EULAR “Train the trainers” course. Ann Rheum Dis 2005; 64: 1043–1049.
20. Craig RT: Generalization of Scott’s index of intercoder agreement. Public Opinion Quarterly 1981; 45: 260–264.
21. Middleton WD, Teefey SA, Yamaguchi K: Sonography of the rotator cuff: analysis of interobserver variability. AJR Am J Roentgenol 2004; 183: 1465–1468.
22. Naredo E, Möller I, Moragues C, de Agustín JJ, Scheel AK, Grassi W et al.: Interobserver reliability in musculoskeletal ultrasonography: results from a “Teach the Teachers” rheumatologist course. Ann Rheum Dis 2006; 65: 14–19. 23. Leroux JL, Thomas E, Bonnel F, Blotman F: Diagnostic value of clinical tests for shoulder impingement syndrome. Rev Rhum Engl Ed 1995; 62: 423–428.
24. Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG: Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am 2005; 87: 1446–1455.
25. Caliş M, Akgün K, Birtane M, Karacan I, Caliş H, Tüzün F: Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis 2000; 59: 44–47.
26. MacDonald PB, Clark P, Sutherland K: An analysis of the diagnostic accuracy of the Hawkins and Neer subacromial impingement signs. J Shoulder Elbow Surg 2000; 9: 299–301.
27. Gerber C, Krushell RJ: Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br 1991; 73: 389–394.
28. Barth JR, Burkhart SS, De Beer JF: The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy 2006; 22: 1076–1084. 29. Walch G, Boulahia A, Calderone S, Robinson AH: The ‘dropping’ and ‘hornblower’s’ signs in evaluation of rotator-cuff tears. J Bone Joint Surg Br 1998; 80: 624–628.
30. Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB: Abnormal fi ndings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am 1995; 77: 10–15.
31. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H: Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg 2010; 19: 116–120.
32. Speed CA, Hazleman BL: Calcifi c tendinitis of the shoulder. N Engl J Med 1999; 340: 1582–1584. 33. Bosworth BM: Examination of the shoulder for calcium deposits.
J Bone Joint Surg Am 1941; 23: 567–577.
34. Le Goff B, Berthelot JM, Guillot P, Glémarec J, Maugars Y: Assessment of calcific tendonitis of rotator cuff by ultrasonography: Comparison between symptomatic and asymptomatic shoulders. Joint Bone Spine 2010; 77: 258–263.
35. Buttaci CJ, Stitik TP, Yonclas PP, Foye PM: Osteoarthritis of the acromioclavicular joint: a review of anatomy, biomechanics, diagnosis, and treatment. Am J Phys Med Rehabil 2004; 83: 791–797.
36. Murthi AM, Vosburgh CL, Neviaser TJ: The incidence of pathologic changes of the long head of the biceps tendon. J Shoulder Elbow Surg 2000; 9: 382–385.
37. Stein BE, Wiater JM, Pfaff HC, Bigliani LU, Levine WN: Detection of acromioclavicular joint pathology in asymptomatic shoulders with magnetic resonance imaging. J Shoulder Elbow Surg 2001; 10: 204–208.
38. Bonsell S, Pearsall AW 4th, Heitman RJ, Helms CA, Major NM, Speer KP: The relationship of age, gender, and degenerative changes observed on radiographs of the shoulder in asymptomatic individuals. J Bone Joint Surg Br 2000; 82: 1135–1139.
39. Holtby R, Razmjou H: Accuracy of the Speed’s and Yergason’s tests in detecting biceps pathology and SLAP lesions: Comparison with arthroscopic findings. Arthroscopy 2004; 20: 231–236.
40. Carter AN, Erikson SM: Proximal biceps tendon rupture: primarily an injury of middle age. Phys Sportsmed 1999; 27: 95–101.
41. Miller R, Dlabach J: Sports medicine. In: Canale ST, Beaty JH (eds.):Campbell’s operative orthopaedics, 11th ed. Mosby Elsevier, Philadelphia (PA) 2007: 2601–775.
42. Kannus P, Józsa L: Histopathological changes preceding spontaneous rupture of the tendon. A controlled study of 891 patients. J Bone Joint Surg Am 1991; 73: 1507–1525.
43. Tamborrini G: Musculoskeletal Ultrasound of the Shoulder: Sonoanatomy. Books on Demand, 2013.
44. Tamborrini G, Marx C: Muskuloskelettaler Ultraschall – 2nd edition. Books on Demand, 2014.