Moosmayer S, Heir S, Aaser P, Smith HJ.

Ortopedisk avdeling, Martina Hansens Hospital, 1306 Baerum postterminal. docmoses@online.no

Ultrasound examination of the shoulder in orthopaedics is not much used in Norway, but it is an established method in many institutions abroad. According to the literature, good results have been obtained with diagnostic ultrasound for demonstration of rotator cuff ruptures and abnormalities of the long tendon of the biceps muscle. In order to increase the knowledge of this diagnostic modality in Norway, we present the general principles and techniques of shoulder ultrasonography. Examples of normal and pathological ultrasound findings in the rotator cuff and long tendon of the biceps muscle are given.

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Moosmayer S, Smith HJ.

Department of Orthopaedic Surgery, Martina Hansen's Hospital, Baerum, Norway. docmoses@online.no

BACKGROUND: Diagnostic ultrasound examination of the shoulder is generally considered to require long experience. We examined the results of an orthopedic surgeon with little experience of ultrasound. PATIENTS AND METHODS: A relatively inexperienced examiner performed preoperative ultrasound scanning of 79 patients with symptoms from the rotator cuff and/or the long head of the biceps muscle. Tears of the rotator cuff and rupture or dislocation of the long head of the biceps muscle were the positive findings of interest. Results were compared to operative findings. RESULTS: In 66 of 79 shoulders, ultrasonographic rotator cuff findings were confirmed at surgery (accuracy 84%). 20 of 26 full-thickness tears were diagnosed correctly. 6 of 7 partial-thickness tears were overlooked. Ultrasound was false positive in 1 case. For the long head of the biceps muscle, all 8 cases of dislocation or rupture of the tendon were diagnosed but differentiation between the two conditions was not possible in 2 cases. INTERPRETATION: Our results may encourage orthopedic surgeons to start using ultrasound as a diagnostic technique for full-thickness tears of the rotator cuff and for pathology in the long head of the biceps muscle.
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Nielsen PK, Jensen BR, Darvann T, Jørgensen K, Bakke M.

Department of Physiology, National Institute of Occupational Health, Denmark. pkn@ami.dk

BACKGROUND: The echogenicity patterns of ultrasound scans contain information of tissue composition in muscles. The aim was: (1) to develop a quantitative ultrasound image analysis to characterize tissue composition in terms of intensity and structure of the ultrasound images, and (2) to use the method for characterization of ultrasound images of the supraspinatus muscle, and the vastus lateralis muscle. METHODS: Computerized texture analyses employing first-order and higher-order grey-scale statistics were developed to objectively characterize ultrasound images of m. supraspinatus and m. vastus lateralis from 9 healthy participants. RESULTS: The mean grey-scale intensity was higher in the vastus lateralis muscle (p < 0.05) than in the supraspinatus muscle (average value of middle measuring site 51.4 compared to 35.0). Furthermore, the number of spatially connected and homogeneous regions (blobs) was higher in the vastus lateralis (p < 0.05) than in the supraspinatus (average for m. vastus lateralis: 0.092 mm(-2) and for m. supraspinatus: 0.016 mm(-2)). CONCLUSION: The higher intensity and the higher number of blobs in the vastus lateralis muscle indicates that the thigh muscle contained more non-contractile components than the supraspinatus muscle, and that the muscle was coarser. The image analyses supplemented each other and gave a more complete description of the tissue composition in the muscle than the mean grey-scale value alone.
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Rutten MJ, Jager GJ, Blickman JG.

Department of Radiology, Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL s-Hertogenbosch, the Netherlands. M.Rutten@JBZ.nl

High-resolution ultrasonography (US) has gained increasing popularity as a diagnostic tool for assessment of the soft tissues in shoulder impingement syndrome. US is a powerful and accurate method for diagnosis of rotator cuff tears and other rotator cuff abnormalities, provided the examiner has a detailed knowledge of shoulder anatomy, uses a standardized examination technique, and has a thorough understanding of the potential pitfalls, limitations, and artifacts. False-positive sonographic findings of rotator cuff tears can be caused by the technique (anisotropy, transducer positioning, acoustic shadowing by the deltoid septum), by the anatomy (rotator cuff interval, supraspinatus-infraspinatus interface, musculotendinous junction, fibrocartilaginous insertion), or by disease (criteria for diagnosis of rotator cuff tears, tendon inhomogeneity, acoustic shadowing by scar tissue or calcification, rotator cuff thinning). False-negative sonographic findings of rotator cuff tears can be caused by the technique (transducer frequency, suboptimal focusing, imaging protocol, transducer handling), by the anatomy (nondiastasis of the ruptured tendon fibers, posttraumatic obscuration of landmarks), by disease (tendinosis, calcifications, synovial proliferation, granulation or scar tissue, bursal thickening, massive rotator cuff tears), or by patient factors (obesity, muscularity, limited shoulder motion). (c) RSNA, 2006.

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