Sonographic evaluation of the shoulder in asymptomatic elderly subjects with diabetes

Abstract

Background: The prevalence of rotator cuff tears increases with age and several studies have shown that diabetes is associated with symptomatic shoulder pathologies. Aim of our research was to evaluate the prevalence of shoulder lesions in a population of asymptomatic elderly subjects, normal and with non insulin - dependent diabetes mellitus.

Methods: The study was performed on 48 subjects with diabetes and 32 controls (mean age: 71.5 ± 4.8 and 70.7 ± 4.5, respectively), who did not complain shoulder pain or dysfunction. An ultrasound examination was performed on both shoulders according to a standard protocol, utilizing multiplanar scans.

Results: Tendons thickness was greater in diabetics than in controls (Supraspinatus Tendon: 6.2 ± 0.09 mm vs 5.2 ± 0.7 mm, p < 0.001; Biceps Tendon: 4 ± 0.8 mm vs 3.2 ± 0.4 mm, p < 0.001). Sonographic appearances of degenerative features in the rotator cuff and biceps were more frequently observed in diabetics (Supraspinatus Tendon: 42.7% vs 20.3%, p < 0.003; Biceps Tendon: 27% vs 7.8%, p < 0.002).Subjects with diabetes exhibited more tears in the Supraspinatus Tendon (Minor tears: 15 (15.8%) vs 2 (3.1%), p < 0.03; Major tears: 15 (15.8%) vs 5 (7.8%), p = ns), but not in the long head of Biceps. More effusions in subacromial bursa were observed in diabetics (23.9% vs 10.9%, p < 0.03) as well as tenosynovitis in biceps tendon (33.3% vs 10.9%, p < 0.001).In both groups, pathological findings were prevalent on the dominant side, but no difference related to duration of diabetes was found.

Conclusions: Our results suggest that age - related rotator cuff tendon degenerative changes are more common in diabetics.Ultrasound is an useful tool for discovering in pre - symptomatic stages the subjects that may undergo shoulder symptomatic pathologies.

Figure 1

Ultrasound appearance of normal and degenerated Supraspinatus Tendon. Panel a) Transverse scan: a normal fibrillar pattern and thickness of Supraspinatus Tendon is observed (between calipers). Panel b) Supraspinatus Tendon is thickened (calipers), hypoechoic, dishomogeneous, with loss of the normal fibrillar pattern. In this picture, an effusion in the subacromial bursa is present (*). 1) Supraspinatus tendon; 2) Biceps tendon; H) Humeral head; D) Deltoid muscle.

Figure 2

Supraspinatus Tendon tears. Panel a) Longitudinal scan: an intratendinous partial thickness tear is reported as focal hypoechoic discontinuity (calipers) with irregular margins. Panel b) Transverse scan: a full defect in the tendon from the bursal to the articular margin, filled with anechoic fluid, is observed (calipers). 1) Supraspinatus tendon; H) Humeral head; D) Deltoid muscle.

Figure 3

Tenosynovitis of the Biceps tendon. Panel a) Biceps tendon into the bicipital groove (transverse scan): the fibrillar pattern and thickness are normal. Panel b) Fluid around the tendon (*) expands the synovial sheet (arrows) expression of tenosynovitis. A mild thickening of Biceps tendon is observed. 1) Biceps tendon; BG) Bicipital groove; D) Deltoid muscle.