investigations

Last reviewed 01/2018

• radiography:
• calcification where the cuff inserts on the greater tuberosity is commonly seen in chronic tendinitis
• erosion of the acromium process and a high riding humeral head may be seen in a long standing tear
• osteoarthritis of the acromioclavicular joint - common finding in older patients

• ultrasonography

• MRI - effective for visualising inflammation and tears

• arthroscopy - permits diagnosis and treatment

Notes (1):

• ultrasound and MRI scanning are the two most useful investigations in diagnosis of rotator cuff impingement pathology
  • in the past MRI was considered as the investigation of choice however evidence suggests MRI and ultrasound to be comparable in both sensitivity and specificity in diagnosing a partial- or a full-thickness cuff tear
    • the only limitation of ultrasound is that it is largely operator dependent
    • most of the specialist shoulder surgeons in the UK utilise ultrasound to screen patients with shoulder pain as it is the most costeffective imaging method for investigating rotator cuff tears
    • caution must be exercised when interpreting MR findings because some individuals may have significant rotator cuff findings on MRI but remain completely clinically asymptomatic
  • for those anticipating a surgical procedure, a preoperative scan can be helpful in determining the size and potential tear configuration, including retraction, delamination and thinning - factors that need to be considered in surgical planning; in assessing the presence or absence of atrophy or fatty infiltration, both important prognostic factors; and in establishing the presence of comorbidities such as partial biceps or labral tears
    
    
  • Sensitivity and specificity of various diagnostic modalities in establishing a diagnosis of rotator cuff disorders

  •  

    	Sensitivity (%)	Specificity (%)
    Clinical Examination	90	50
    Ultrasound	85	92
    Magnetic resonance imaging	86	90
    Magnetic resonance arthrography	92	97

Reference:

• 1) Arthritis Research Campaign (2010). Topical reviews - managing rotator cuff tears.