Painful shoulder: comparison of physical examination and ultrasonographic findings

Abstract

Background: High frequency ultrasonography is an accurate non-invasive imaging technique for evaluating patients with painful shoulder.

Objective: To compare the clinical diagnosis established by a physical examination with high frequency ultrasonographic findings in patients with painful shoulder.

Methods: Thirty one consecutive patients with a first flare of shoulder pain were prospectively included in the study. All had a physical examination performed by two blinded rheumatologists. Ultrasonographic examination was carried out within one week of the physical examination by a third rheumatologist experienced in this technique who had no knowledge of the clinical findings. Ultrasonography was considered the optimal diagnostic technique.

Results: Clinical assessment showed low accuracy in the diagnosis of periarticular shoulder lesions.

Conclusion: Ultrasonography should be used wherever possible to improve diagnosis and treatment of painful shoulder.

Figure 1

Ultrasonographic transverse imaging of biceps tendinitis (left) compared with normal biceps tendon (right). Note the increased hypoechoic fluid (F) within the biceps tendon sheath, surrounding the hyperechoic tendon. BG = Bicipital groove.

Figure 2

Ultrasonographic longitudinal imaging of a deep surface supraspinatus partial thickness tear. Note the hypoechoic fluid (F) filling the fibre defect. GT = Greater tuberosity of the humerus; SST = supraspinatus tendon; DM = deltoid muscle.