Ultrasonographic findings of the shoulder in patients with rheumatoid arthritis and comparison with physical examination

Abstract

The objectives of this study were: 1) to identify the ultrasonographic (US) abnormalities and 2) to compare the findings of physical examination with US findings in rheumatoid arthritis (RA) patients with shoulder pain. We studied 30 RA patients. Physical examination was performed systemically as follows: 1) area of tenderness; 2) range of passive and active shoulder motion; 3) impingement tests; 4) maneuvers for determining the location of the tendon lesions. US investigations included the biceps, the supraspinatus, infraspinatus, and subscapularis tendons; the subacromial-subdeltoid bursa; and the glenohumeral and acromioclavicular joints. Thirty RA patients with 35 painful and 25 non-painful shoulders were examined. The range of motion affected the most by shoulder pain was abduction. The most frequent US finding of shoulder joint was effusion in the long head of the biceps tendon. Among the rotator cuff tendons, subscapularis was the most frequently involved. Tendon tear was also common among non-painful shoulders. Physical examination used for the diagnosis of shoulder pain had low sensitivity and specificity for detecting abnormalities in the rheumatoid shoulder joint. In conclusion, US abnormalities showed frequent tendon tears in our RA patients. Physical examination had low sensitivity and specificity for detecting rotator cuff tear in the rheumatoid shoulder joint.

Fig. 1

Ultrasonographic findings of biceps abnormalities. (A, B) Biceps effusion with pannus (arrow) in biceps tendon sheath. (C, D) Biceps tendon rupture with empty sheath. (A, C) Transverse view. (B, D) Longitudinal view.

Fig. 2

Partial thickness tear in subscapularis tendon (arrow) in a non-painful shoulder. (A) Transverse view. (B) Longitudinal view.

Fig. 3

Complete massive tear in supraspinatus in a non-painful shoulder. (A) Transverse view. (B) Longitudinal view.

Fig. 4

Bilateral partial thickness tear in infraspinatus in one patient. Transverse view. (A) Painful shoulder. (B) Non-painful shoulder.