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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 7, 889-892.
doi: 10.1302/0301-620X.90B7.20481  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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The detection of full thickness rotator cuff tears using ultrasound

A. Al-Shawi, FRCS (Tr&Orth), Specialist Registrar1; R. Badge, MBBS, Senior House Officer2; and T. Bunker, MD, FRCS, MCH(Orth), Consultant Orthopaedic and Shoulder Surgeon2

1 Orthopaedic Department, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, UK.
2 Princess Elizabeth Orthopaedic Centre Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX1 5DW, UK.

Correspondence should be sent to Mr T. Bunker; e-mail: tim.bunker{at}exetershoulderclinic.co.uk

We have examined the accuracy of 143 consecutive ultrasound scans of patients who subsequently underwent shoulder arthroscopy for rotator-cuff disease. All the scans and subsequent surgery were performed by an orthopaedic surgeon using a portable ultrasound scanner in a one-stop clinic. There were 78 full thickness tears which we confirmed by surgery or MRI. Three moderate-size tears were assessed as partial-thickness at ultrasound scan (false negative) giving a sensitivity of 96.2%. One partially torn and two intact cuffs were over-diagnosed as small full-thickness tears by ultrasound scan (false positive) giving a specificity of 95.4%. This gave a positive predictive value of 96.2% and a negative predictive value of 95.4%. Estimation of tear size was more accurate for large and massive tears at 96.5% than for moderate (88.8%) and small tears (91.6%). These results are equivalent to those obtained by several studies undertaken by experienced radiologists.

We conclude that ultrasound imaging of the shoulder performed by a sufficiently-trained orthopaedic surgeon is a reliable time-saving practice to identify rotator-cuff integrity.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General