Rotator cuff tears: Clinical, radiographic, and US findings
ABSTRACT Rotator cuff tears are a common cause of shoulder pain. Clinical and radiographic findings can suggest the presence of a rotator cuff tear. The most sensitive clinical findings are impingement and the "arc of pain" sign. Radiographic findings are usually normal in the acute setting, although the "active abduction" view may show decreased acromiohumeral distance. In more chronic cases, an outlet view may show decreased opacity and decreased size of the supraspinatus muscle due to atrophy. In late cases, the humeral head may become subluxated superiorly, and secondary degenerative arthritis of the glenohumeral joint may ensue. Ultrasonography (US), with over 90% sensitivity and specificity, can help confirm the diagnosis in clinically or radiographically equivocal cases. US can also reveal the presence of other abnormalities that may mimic rotator cuff tear at clinical examination, including tendinosis, calcific tendinitis, subacromial subdeltoid bursitis, greater tuberosity fracture, and adhesive capsulitis.
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ABSTRACT: Rotator cuff tears are a common and disabling complaint. The early diagnosis of medium and large size rotator cuff tears can enhance the prognosis of the patient. The aim of this study was to identify clinical features with the strongest ability to accurately predict the presence of a medium, large or multitendon (MLM) rotator cuff tear in a primary care cohort. Participants were consecutively recruited from primary health care practices (n = 203). All participants underwent a standardized history and physical examination, followed by a standardized X-ray series and diagnostic ultrasound scan. Clinical features associated with the presence of a MLM rotator cuff tear were identified (P<0.200), a logistic multiple regression model was derived for identifying a MLM rotator cuff tear and thereafter diagnostic accuracy was calculated. A MLM rotator cuff tear was identified in 24 participants (11.8%). Constant pain and a painful arc in abduction were the strongest predictors of a MLM tear (adjusted odds ratio 3.04 and 13.97 respectively). Combinations of ten history and physical examination variables demonstrated highest levels of sensitivity when five or fewer were positive [100%, 95% confidence interval (CI): 0.86-1.00; negative likelihood ratio: 0.00, 95% CI: 0.00-0.28], and highest specificity when eight or more were positive (0.91, 95% CI: 0.86-0.95; positive likelihood ratio 4.66, 95% CI: 2.34-8.74). Combinations of patient history and physical examination findings were able to accurately detect the presence of a MLM rotator cuff tear. These findings may aid the primary care clinician in more efficient and accurate identification of rotator cuff tears that may require further investigation or orthopedic consultation.The Journal of manual & manipulative therapy 08/2013; 21(3):148-59. DOI:10.1179/2042618612Y.0000000020
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ABSTRACT: To study the shoulder of this group of patients using magnetic resonance imaging to detect clinical and subclinical disorders and establish a rehabilitation program. Nine patients with spinal cord injury followed in the Laboratory of Biomechanics and Rehabilitation of the Locomotive System at HC/UNICAMP were divided into two groups according to the presence of paraplegia and tetraplegia and were clinically assessed for correlation with the imaging exams. Normal results were found in 41% of the shoulders. Most common injuries were tendinopathy of the supraspinatus and acromioclavicular joint degeneration. Eighty percent of injured shoulders had combined lesions. A great variety of causes of shoulder pain was identified in paraplegic and tetraplegic subjects. Routine clinical assessment and imaging studies of the shoulder may contribute to the evolution of rehabilitation and reduction of pain and musculoskeletal disorders. Level of Evidence II, Development of Diagnostic Criteria on Consecutive Patients, With Universally Applied Reference "Gold" Standard.Acta Ortopédica Brasileira 03/2012; 20(5):291-6. DOI:10.1590/S1413-78522012000500009 · 0.16 Impact Factor
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ABSTRACT: Background The present study aimed to assess the accuracy and characterize the learning curve of surgeon-lead shoulder ultrasound scans (USS) performed in outpatients for suspected rotator cuff tears, with intra-operative findings considered as the gold standard. Methods From 2009 to 2011, all patients having arthroscopic shoulder surgery by the senior author were identified. Clinic letters were reviewed to identify those who had undergone USS in clinic. This was then compared with the operating findings. Results A total of 66 patients had an USS and proceeded to arthroscopic shoulder surgery during that time. Overall sensitivity and specificity was 0.86 and 0.70, respectively. Comparing values from 2009 to 2011: specificity improved from 0.50 to 0.8; sensitivity remained much the same with 2009 values of 0.88 to 2011 values of 0.86. Conclusions The results reflect good sensitivity and specificity, which was comparable with that reported in the literature. There was an improvement in specificity over time displaying a learning curve and emphasizing the question of how much experience in shoulder USS is required before it can be relied upon as the patient's primary imaging preoperatively?Shoulder & Elbow 01/2013; 5(1). DOI:10.1111/j.1758-5740.2012.00223.x