RELIABILITY OF SHOULDER ULTRASOUND TO DETECT ROTATOR CUFF TEARS WHEN PERFORMED BY THE SURGEON IN THE PLACE OF FIRST CONTACT

Abstract

Ultrasound has become an essential adjunct to clinical examination when assessing a patient with suspected rotator cuff pathology. This prospective study was conducted to examine the accuracy of the scans performed by a surgeon over a period of four years.

Out of 276 scanned patients we selected 143 who ultimately received an operation and we compared the findings with the ultrasound reports.

The surgical findings included 77 full thickness tears, 24 partial thickness tears and 42 normal cuffs. Two small tears were missed and one partial thickness tear was reported as full thickness. This presents a 98.6% sensitivity and 99.3% specificity for full thickness tears. Three partial thickness tears were reported normal on ultrasound and eight normal cuffs as partial thickness tears. This presents a 97.9% sensitivity and 94.4% specificity for partial thickness tears. The size estimation of full thickness tears was more accurate for large/massive tears (96%) than moderate (82%) and small/pinhole tears (75%). The tear sizes were more often underestimated which may partly reflect disease progression during the unavoidable time lag between scan and surgery.

We conclude that shoulder ultrasound performed by a sufficiently trained orthopaedic surgeon is a safe and reliable practice to identify rotator cuff tears.